前入路原位脾切除术在临床中的应用

Clinical application of anterior route splenectomy

目的探讨前入路原位脾切除术在临床中的应用前景。方法回顾性分析2011年1月至2015年7月巨脾切除术69例患者,行前入路原位脾切除术32例（原位组）与传统脾切除术37例（传统组）的临床资料。应用SPSS19.0软件包进行处理。手术时间、术中出血等计量资料比较用t检验,术后并发症等资料用χ~2检验,P〈0.05具有统计学差异。结果原位组脾热和胰瘘的发生率（分别为9.4%和0）比传统组（分别为29.7%和16.2%）明显降低（χ~2值分别为4.396和5.683,P〈0.05）,手术时间和出血量无显著性差异（P〉0.05）,两组术后均无继发性脾蒂出血（P〉0.05）。结论前入路原位脾切除术可降低患者术后胰瘘、脾热发生率,预防脾蒂继发出血,尤其对于脾脏较大的患者,是一种值得提倡的手术方式。

Objective To evaluate the clinical application of anterior route splenectomy.Methods Using the retrospective analysis we compared operation time,blood loss,incidence rate of complications of patients who underwent splenectomy in Yixing People＇s Hospital from January 2011 to July2015 by an anterior approach（ 32 patients） and a conventional group（ 37 patients）. SPSS19. 0 software package was used for data analysis. Operation time and blood loss volume were compared by Student＇s t test,and the data of post-operative complications were evaluated with the Chi-square test. P〈0. 05 was considered statistically significant. Results The incidences of spleen fever and pancreatic fistula（ 9. 4%and 0,respectively） were significantly lower in the anterior approach group（ χ~2： 4. 396 and 5. 683,P〈0. 05） than those in the conventional group（ 29. 7% and 16. 2%）. The operation time and blood loss are no significantly different between the two groups（ P〉0. 05）. There were no secondary splenic pedicle bleeding in the two groups（ P〉0. 05）. Conclusion The anterior approach splenectomy could decrease the incidence of pancreatic fistula and spleen fever and prevent secondary splenic pedicle bleeding in patients undergoing splenectomy. It is a valuable operation for patients with large spleen.