腔镜直线型切割缝合器在开腹脾切除术中的应用研究

Application of endoscopic linear cutter in the open splenectomy

目的：对比应用腔镜直线型切割缝合器行开腹脾切除术与传统脾切除术的临床效果。方法回顾性分析沈阳军区总医院急诊外科2010年1月至2014年1月收治的因外伤性脾破裂行开腹脾切除手术50例患者的病历资料，将2012年1月至2014年1月应用腔镜直线型切割缝合器行脾切除术患者28例作为观察组，2010年1月至2012年1月采用传统脾切除术患者22例作为对照组，对比两组在手术时间、术后引流量、术后并发症发生率及出血量等方面的差异。结果与对照组比较，观察组手术时间明显缩短，术区引流量较少，术后再出血、脾热、胰漏等并发症发生率明显降低，差异均有统计学意义（均P<0.05）。而在出血量方面二者差异无统计学意义（P>0.05）。结论创伤性脾破裂行开腹脾切除术中应用腔镜直线型切割缝合器可快速、安全、有效地离断脾蒂血管，减少手术时间及术后并发症的发生，较传统手术方式优势显著，值得临床推广应用。

Objective To compare the clinical effects between conventional splenectomy and application of endoscopic linear cutter in the open splenectomy. Methods From January 2010 to January 2014,we performed retrospective study on 50 patients who received open splenectomy due to traumatic splenic rupture in the General Hospital of Shenyang Military Region.28 cases of these patients received open splenectomy using endoscopic linear cutter(observation group),while 22 cases of them received conventional splenectomy(control group). We compared the two groups on factors including operating time, surgical drainage, complications, and introperative blood loss. Results The observation group showed significantly better result in operating time, surgical drainage and occurrence of complications such as blood loss post surgery, spleen fever, and pancreatic fistula(P<0.05).However, no significant difference has been observed in introperative blood loss (P>0.05). Conclusion Application of endoscopic linear cutter in open splenectomy on cases of traumatic splenic rupture enables resection of splenic pedical fast, safely and effectively, decreasing operating time and occurrence of complications, which has evident advantages compared with the conventional surgery and is worthy of being wider used in clinic.