腹腔镜下脾切除术与开腹脾切除术的疗效对比及应用体会

Efficacy and experience of laparoscopic splenectomy compared with open splenectomy

目的探讨腹腔镜脾切除术(LS)在治疗各类脾脏疾病中的安全性及临床疗效。方法回顾分析性完成的40例腹腔镜下脾切除术和41例开腹脾切除术的临床资料。结果 LS病人与开腹脾切除术病人在年龄、性别、疾病类别及脾脏最大直径方面均差异无统计学意义(P>0.05)。40例LS均顺利完成,无术中中转开腹。腹腔镜手术组病人的手术时间显著长于开腹手术时间(P<0.05),但失血量和切口并发症较少(P<0.05),术后胃肠功能恢复较快(P<0.05)。两组术后住院时间差异无统计学意义(P>0.05)。1例腹腔镜脾切除病人术后2 h出现不明原因心脏骤停。两组均无手术死亡病例。结论在严格掌握适应证及具有良好的腹腔镜技术和经验前提下,LS安全可行,能应用于各类脾脏疾病的手术治疗。

Objective To investigate the safety and efficacy of laparoscopic splenectomy(LS)in the treatment of various splenic disorders.Methods We performed a retrospective analysis of40cases undergoing LS compared with41cases receiving open splenectomy(OS).Results No significant differences were observed between the LS group and the OS group in terms of age,gender,disease classification and the longest diameter of the spleen(P>0.05).LS was successfully completed in40cases without an immediate conversion to open surgery.Patients in the LS group had significantly longer operative tim e(P<0.05),less intraoperative blood lo ss(P<0.05),lower incidence of wound complications(P<0.05)and less recovery time of postoperative gastrointestinal peristalsis(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).One case in the LS group experienced unexplained cardiac arrest two hours after the operation.No surgery-related death occurred in both groups.Conclusion Under the strict control of indications and good experience of laparoscopy,it is safe and feasible to apply LS in various splenic disorders.