腹腔镜脾切除术联合自体血回输治疗外伤性脾破裂的疗效观察

Effect of laparoscopic splenectomy combined with autologous blood transfusion on traumatic splenic rupture

目的探讨腹腔镜脾切除术联合自体血回输治疗外伤性脾破裂的效果。方法选取汕头大学医学院第二附属医院收治的外伤性脾破裂患者35例作为研究对象,均行腹腔镜脾切除术,术中采用自体血回输,观察两组患者手术情况及术后并发症发生率,记录术前及术后凝血功能,记录两组患者术前和术后2 d白细胞介素-2(IL-2)、白细胞介素6(IL-6)的变化情况。结果 35例患者均完成腹腔镜脾切除术,其中1例中转开腹,无一例患者死亡。手术时间为(119.62±43.26)min,术前腹腔积血量(1469.35±186.32)ml,术中出血量(336.62±27.63)ml,回输自体血(813.06±65.29)ml,住院时间为(11.26±1.09)d;术前和术后2 d IL-2无明显变化(P>0.05);术前和术后TT、PT、APTT、FIB差异均未见统计学意义(P>0.05);术后2 d IL-6为(3084.63±625.84)pg/ml,与术前相比差异有统计学意义(P<0.05)。结论自体血回输血用于腹腔镜脾切除术中,对外伤性脾破裂患者凝血指标和免疫功能的影响较小。

Objective To investigate the effect of laparoscopic splenectomy combined with autologous blood transfusion on traumatic splenic rupture. Methods Thirty-five patients with traumatic splenic rupture admitted into the hospital were selected as the research objects. All of the patients were treated with laparoscopic splenectomy and intraoperative autologous blood transfusion. The operation and incidence of postoperative complications of the two groups and coagulation function before and after surgery were recorded as well as changes of interleukin-2（ IL-2） and interleukin 6（ IL-6） of the two groups 2 d before and after surgery. Results All of the 35 patients completed laparoscopic splenectomy and there was a case converted to laparotomy and no patients died. The average operative time was（ 119. 62 ± 43. 26） min,the mean preoperative volume of hemoperitoneum was（ 1469. 35 ± 186. 32） ml,the average amount of intraoperative bleeding was（ 336. 62 ± 27. 63） ml,the average autologous blood transfusion was（ 813. 06 ± 65. 29） ml,the average time of hospitalization was（ 11. 26 ± 1. 09） d. There was no significant change in 2 d IL-2 before and after surgery（ P〉0. 05）; There was no significant difference in preoperative and postoperative TT,PT,APTT and FIB（ P〉0. 05）; Postoperative 2 d IL-6 was（ 3084. 63 ± 625. 84） pg / ml,which was higher than that of the control group and the difference was significant（ P〈0. 05）. Conclusion Autologous blood transfusion in laparoscopic splenectomy has little influence on coagulation index and immune function of patients with traumatic splenic rupture.