门静脉高压症切脾术式原位法和传统法的对比研究

A comparative study of orthotopic versus traditional splenectomy for patients with portal hypertension

目的 回顾性分析门静脉高压症脾切除术原位法和传统法的优劣,为临床提供一定的指导.方法 查阅华中科技大学同济医学院附属同济医院肝脏外科中心自2006年5月至2012年12月开腹行单纯性脾脏切除术的患者,筛选出存在门静脉高压症的病历,共98例,按照不同手术方法分为原位脾切除组46例,传统脾切除组52例,统计手术时间、术中出血量、输血人数、术后引流量、术后并发症等临床资料,进行统计学分析.结果 原位脾切除组与传统脾切除组的手术时间分别为（122.8±15.5） min、（125.5±18.4）min,P＞0.05;出血量分别为（246.1±114.4） ml、（422.5±153.0）ml,P＜0.01;需术中输血分别为6例、16例,P＜0.05;术后引流管总引流量为（600.5±140.7）ml、（861.2±214.2） ml,P＜0.01;术后胰漏分别为1例、3例,P＜0.05;术后腹腔积液分别为7例、12例,P＜0.05.结论 与传统脾切除组相比,原位脾切除在不增加手术时间的情况下,术中出血量和需输血人数减少,术后胰漏、腹腔积液的并发症发生率降低,术后引流管总引流量减少.在门静脉高压症切脾术式选择中应当优先考虑原位脾切除法.

Objective To compare the advantages and disadvantages of orthotopic versus tradi tional splenectomy so as to offer clinical guidance.Methods A total of 98 patients undergoing splenec tomy for portal hypertension from May 2006 to December 2012 were selected and assigned into ortho topic （n-46） and traditional （n-52） splenectomy groups.Then the clinical data of two groups were analyzed.Results In orthotopic and traditional splenectomy groups,operative duration was 122.78 ± 15.54 vs 125.46 ± 18.36 min,volume of blood loss 246.11 ± 114.43 vs 422.45 ± 153.00 ml,number of blood transfusion 6 vs 16,volume of postoperative drainage 600.46 ± 140.65 vs 861.23 ± 214.18 ml,number of patients with postoperative pancreatic leakage 1 vs 3 and number of patients with post operative seroperitoneum 7 vs 12 respectively.The differences of all of the above parameters had sta tistical significance （P＜0.05）.Conclusions Compared with traditional splenectomy,orthotopic sple nectomy may reduce blood loss and blood transfusion during operation and lower the volume of drain age and the postoperative incidence of pancreatic leakage and seroperitoneum.Orthotopic splenectomy is preferred for patients with portal hypertension.