可吸收网包裹保创伤脾对术后免疫学影响的临床研究

Clinical Study on the Effect of Traumatic Spleen Encapsulated with Absorbable Vicryl Mesh on Postoperative Immunology

目的探讨外伤性脾破裂行可吸收网包裹保脾的对术后免疫学的影响。方法 30例外伤性重度脾破裂患者根据手术方式的不同随机分实验组（保脾组）和对照组（非保脾组）,术后均在第1周、2周、4周进行免疫学（IgG、IgM、CD4、CD8）检查,另外微乔网包裹保脾进行超声造影检查。结果 30例患者患者全部康复出院,实验者术后超声造影检查示体积为正常脾脏40%~90%,无脾梗死、粘连性肠梗阻、腹腔感染及全身感染等并发症发生。术后免疫学检查指标IgM和CD4实验组明显高于对照组（P〈0.05）。结论通过对破裂脾以微乔网包裹保脾手术,术后超声增强造影对保留脾脏的形态及血供观察,证实该方法对脾破裂的止血是快捷、安全、有效的,并减少因脾切除而导致的免疫力下降、爆发性感染等不良后果及减轻伤残程度,提高脾破裂的抢救成功率。

Objective To study the effect of traumatic spleen encapsulated with absorbable vicryl mesh on postoperative immunology. Methods 30 patients of severe traumatic spleen were divid into 2 groups： experimental group （traumatic spleen encapsulated with absorbable vicryl mesh） and control group. The immunological examination （IgG, IgM, CD4, CD8） were preformed 1 week, 2 weeks and 4 weeks after the operation. The experimental group received the contrast-enhanced ultrasound examination. Results All 30 patients were recovered and no splenic infarction, adhesive intestinal obstruction, abdominal infection or general infection was found. The immunological examination showed that the IgM and CD4 in the experimental group were significantly higher than those in the control group （P 0.05）. Conclusions The traumatic spleen encapsulated with absorbable vicryl mesh is fast, safe and effective for hemostasis, which reduces the negtive effects such as immunity decline and overwhelming infection caused by splenectomy, improve the successful rescue rate of splenic rupture.