腹腔镜脾切除治疗Ⅲ级以上脾损伤临床经验

Clinical experience of emergency laparoscopic splenectomy for treating splenic trauma of grade Ⅲ and above

目的探讨腹腔镜脾切除治疗Ⅲ级以上外伤性脾破裂的适应证及临床效果,为微创治疗外伤性脾破裂的适应证选择提供参考。方法收集吉林大学第一医院2011年8月—2016年6月腹腔镜脾切除治疗的32例Ⅲ级以上外伤性脾破裂患者临床资料,分析手术时间、术中出血量、术后住院时间、术后并发症等。所有患者均为外伤性脾破裂,无其他严重的合并伤。其中Ⅲ级损伤19例(59.4%),Ⅳ级损伤10例(31.2%),Ⅴ级损伤3例(9.4%)。结果所有患者均成功完成脾切除术,其中27例腹腔镜手术获成功,5例中转开腹。自体血回输24例(75.0%),输血31例(96.9%),术中出血量(1682±582)m L,手术时间(145.5±62.5)min,术后禁食时间(2.9±1.9)d,术后住院(8.6±5.4)d。并发症发生率12.5%(4/32),其中胰漏1例,胸腔积液1例,感染相关2例。本组无死亡病例及严重并发症发生。结论腹腔镜脾切除治疗Ⅲ级以上外伤性脾破裂具有微创、恢复快、并发症少、住院时间短等优点,微创手术安全、可行,值得临床推广。

ObjectiveTo discuss the indication and clinical effects of emergency laparoscopic splenectomy for treating splenic trauma of gradeⅢand above.MethodsClinical data of32traumatic splenic rupture patients was collected and analyzed,who underwent emergency laparoscopic splenectomy from Aug.2011to Jun..2016in our hospital.The following data including operative time,intraoperative blood loss volume,average hospital stay and postoperative complications was analyzed.All patients were traumatic spleen rupture without severe combined injuries.There were19cases of gradeⅢ(594%),10cases of gradeⅣ(312%),and3cases of gradeⅤ(94%).ResultsTwenty seven cases achieved successful lapatoscopic slpenectomy and5cases were transferred to laparotomy.There were24cases of intraoperative autologous blood transfusion(750%),and31cases of blood transfusion(969%).The average peri operative bleeding was(1682±582)mL,average operative time was(1455±625)min,the average postoperative fasting time was(29±19)d,and the average postoperative hospital stay was(86±54)d.The overall postoperative morbidity rate was125%(4/30),including1case of pancreatic leakage,1case of pleural effusion,and2cases of infections.There was no death case and serious complications.ConclusionEmergency laparoscopic splenectomy for treating splenic trauma of gradeⅢand above has advantages such as mini invasion,fast recovery,few complications and short hospital stay.Minimally invasive operations are safe and feasible,and deserve further clinical applications.