术前脾动脉多层CT血管成像检查对腹腔镜脾切除术的指导意义

Instructive value of preoperative splenic artery CTA examination in laparoscopic splenectomy

目的 探讨术前脾动脉多层CT血管成像（CTA）检查对腹腔镜脾切除术（LS）的指导意义.方法 2008年1月至2010年2月完成腹腔镜脾切除术（LS）36例,随机分为CTA组和常规手术组各18例.CTA组术前行脾动脉CTA检查,分析脾动脉及其分支解剖类型和走行,制定个体化手术方案,完成LS术.常规手术组采取常规术式手术,完成LS术.对比CTA组术前CTA记录与术中记录的各项指标的例数及其构成比,采用χ2检验,观察二者是否符合.对2组的手术时间、出血量加以比较.结果 术前脾动脉CTA检查与术中录像所记录各项指标基本符合,差异无统计学意义（P〉0.05）.CTA组较常规手术组手术时间短[分别为（124.32±21.43）min与（148.27±28.36）min],出血量少[分别为（80.50±16.42）ml与（101.35±26.25）ml],差异有统计学意义（P〈0.05）. 结论术前脾动脉CTA可明确脾动脉及其分支解剖类型和走行.指导制定个性化手术方案,增加手术的安全性,减少术中出血,缩短手术时间,对腹腔镜脾切除术有指导意义.

Objective To explore the instructive value of preoperative splenic artery CTA examination on Laparoscopic splenectomy （LS）. Methods From January 2008 to February 2010,36 cases requiring Laparoscopic splenectomy （LS） were selected randomly and divided into two groups： CTA group and non-CTA group, 18 cases in each group. As for the CTA group,splenic artery CTA examination was performed before operation,to understand splenic artery and its branches anatomy type and track and then individualized surgical treatment was developed. As for the non-CTA group,a routine surgical procedure was performed. The indices before and during the operation were recorded and compared through χ2 test The operating time and the amount of bleeding in the two groups were compared using t-test Results There were no significant difference between the indices recorded by splenic artery CTA examination and those by laparoscopic splenectomy intraoperation （ P 〉 0. 05 ） . The operating time was （124. 32 ±21.43） mins in the CTA group, which was significantly shorter than that in the non-CTA group （（148.27 ±28. 36）mins） （P 〈0. 05）. The amount of blood in the CTA group was significantly less than that in the non-CTA group（ （ 80. 50 ± 16. 42） ml vs. （101. 35 ± 26.25 ） ml）. Conclusions Splenic artery CTA can identify splenic artery and its branches anatomy type and track before LS,therefore guide the development of individualized surgical treatment It increases the safety of LS, reduces bleeding and shortens the operational time. It has an instrutive value to laparoscopic splenectomy.