腹腔镜巨脾切除术与开腹巨脾切除术的术后并发症比较

Postoperative complications of laparoscope megalosplenic resection vs. laparotomy megalosplenic resection

目的比较腹腔镜巨脾切除术与开腹巨脾切除术的术后并发症。方法回顾性分析2010年1月至2015年9月行巨脾切除术病人的临床资料，并按照手术方式分为腹腔镜切除组44例，其中包含31例全腹腔镜巨脾切除病例和13例手助腹腔镜巨脾切除病例，开腹切除组42例，并分别比较两组病例的术后并发症。结果2组手术均顺利完成，无手术死亡，其中腹腔镜组3例中转开腹。腹腔镜组和开腹组相比，术后感染率（13．6％和35．7％）及腹腔积液率（6．8％和23．8％）腹腔镜组明显低于开腹组，而胰漏、术后出血及术后门静脉系统血栓的风险性两者相比差异无统计学意义。在腹腔镜组中，手助组与全腹腔镜组相比，在术后并发症率上差异无统计学意义。结论腹腔镜脾脏切除术是一项安全和有效的巨脾切除技术。手助腹腔镜脾切除术与全腹腔镜脾切除术预后相当，必要时可以使用。

Objective To compare postoperative complications of laparoscope megalosplenic re- section vs. laparotomy megalospenic resection. Methods The clinical data of patients subject to megalosplenic resection in our hospital from Jan. 2010 to Sept. 2015 were retrospectively analyzed and divided into laparoscope resection group （n = 42, including 31 cases of total laparoscope megalosplenic resection and 13 cases of hand-assisted laparoscope megalosplenic resection） and laparotomy resection group （n = 42） according to the operation methods, and complications were compared between two groups. Results All operations in two groups were successful without operation deaths. Three cases in laparoscope resection group were converted to laparotomy resection. The postoperative infection rate and seroperitoneum rate of laparoscope in resection group wee obviously lower than those in laparotomy resection group, and there was no significant difference in pancreatic leakage, postoperative hemorrhage and the risks of postoperative portal system thrombosis between laparoscope resection group and laparotomy resection group. In laparoscope resection group, there was significant difference in postoperative complication rate between hand-assisted laparoscope megalosplenic resection subgroup and total laparoscope megalosplenic resection subgroup. Conclusions Laparoscopic megalosplenic resection is safe and effective. The prognosis of hand-assisted laparoscope megalosplenic resection is similar to that of total laparoscope megalosplenic resection and is used if necessary.