PSE治疗外伤性脾破裂临床疗效及对患者机体免疫功能的影响

Clinical efficacy of PSE in the treatment of traumatic splenic rupture and its effect on the immune function in patients

目的探讨部分脾栓塞术治疗外伤性脾破裂的临床疗效及其对患者免疫功能的影响。方法对我院2013年1月~2016年5月收治的56例外伤性脾破裂患者临床资料进行回顾性分析,根据其治疗方法分为开腹手术组和PSE治疗组。对两组患者相关临床指标和术前30 min、术后1 d和7 d外周血免疫功能水平进行统计学分析。结果两组患者在术后肠功能恢复时间、开始纳食时间、首次下床时间以及术后总住院治疗时间方面,PSE治疗组均显著短于开腹手术组(P<0.05)。在细胞免疫方面,术后1 d和7 d,两组外周血T细胞免疫功能指标有显著差异,PSE治疗组均高于开腹手术组,差异有统计学意义(P<0.05)。在体液免疫方面,两组患者术后1 d免疫球蛋白水平与本组术前30 min相比均显著下降(P<0.05),两组比较无显著性差异(P>0.05);在术后7 d,PSE治疗组患者免疫球蛋白水平已升至正常,开腹手术组仍显著下降,两组比较PSE治疗组显著高于开腹手术组,差异有统计学意义(P<0.05)。结论相比开腹手术,PSE治疗外伤性脾破裂能显著提高患者的临床疗效,改善患者术后免疫功能水平,且保留了脾脏功能。

Objective To investigate the clinical efficacy of partial splenic embolization in the treatment of traumatic splenic rupture and its effect on immune function in the patients. Methods The clinical data of 56 patients with traumatic splenic rupture who were admitted to our hospital from January 2013 to May 2016 were retrospectively analyzed. According to the therapeutic regimen, the patients were divided into the open surgery group and the PSE treatment group. The relevant clinical data, the immunological function of the peripheral blood at 30 min before the surgery, 1 d and 7 d after the surgery in both group were statistically analyzed. Results In terms of the recovery time of intestinal function, the initiation time of eating, the time of first off-bed activity and the total length of stay, PSE treatment group was significantly shorter than the open surgery group（P〈0.05）. In the aspects of cellular immunity, there were significant differences in T cell immune function indices between the two groups on the 1st and 7th day after operation, and the PSE treatment group was higher than the open surgery group. The difference was statistically significant （P〈0.05）. In terms of the humoral immunity, the level of immunoglobulin in the two groups was significantly lower than that in the control group（P〈0.05）. There was no significant difference between the two groups（P〉0.05）; at 7th day after the surgery, immunoglobulin levels in the PSE group resumed to normal, while the levels in the open surgery group was still decreasing. The PSE group was significantly higher than the open surgery group, and there was statistically significant difference between the two groups （P〈0.05）. Conclusion Compared with the open surgery, PSE in the treatment of trau- matic splenic rupture can significantly improve the clinical efficacy of patients, improve the level of postoperative immune function, and retain the splenic function.