两种脾蒂离断方案在脾脏微创切除手术患者中的疗效比较

Comparison of curative effect of two spleen-pedicle regurgitation programs in patients with minimally invasive splenectomy

目的探究术中经脾蒂上缘间隙切除脾脏的微创切除手术患者的临床疗效。方法选取2012年6月-2017年6月该院收治的152例脾脏切除手术患者为研究对象,所有患者均经腹腔镜脾脏切除术治疗。其中,118例患者术中经脾蒂上缘间隙离断脾蒂作为观察组,34例患者术中未经脾蒂上缘间隙离断脾蒂作为对照组。比较两组患者围术期情况、术后7 d血液学指标和并发症发生情况。结果观察组患者的术中出血量(51.85±27.14)ml、手术时间(69.39±19.34)min和中转开腹率(0.84%)均明显低于对照组患者(82.67±36.29)ml、(119.44±23.73)min和8.82%,差异有统计学意义(P<0.05);两组患者的首次肛门排气时间、进食流质食物时间和住院时间差异无统计学意义(P>0.05)。术后7 d观察组患者的血液白细胞计数(WBC)水平(4.32±1.14)×109/L、血红蛋白(Hb)水平(125.37±18.28)g/L和血小板(PLT)水平(378.28±112.94)×109/L均明显高于对照组患者的(3.28±1.05)×109/L、(97.23±22.43)g/L和(239.42±134.82)×109/L,差异有统计学意义(P<0.05)。观察组患者胰瘘、腹腔出血、门静脉血栓、感染、肠梗阻的发生率均明显低于对照组患者,差异有统计学意义(P<0.05)。结论脾脏微创切除手术患者术中经脾蒂上缘间隙离断脾蒂能够降低术中出血量和中转开腹率,缩短手术时间,降低术后并发症发生率,可在临床上进一步推广和使用。

Objective To study the clinical effect of minimally invasive resection of spleen in the upper margin of the spleen pedicle.Methods152patients underwent splenectomy were enrolled in this study from June2012to June2017.All patients underwent laparoscopic splenectomy.Among the118patients,the spleen pedicle was removed from the spine pedicle of the spleen pedicle and the spleen pedicle was taken as the control group.Comparison of the two groups of patients with perioperative period,7d postoperative hematological indicators and complications occurred.Results The intraoperative blood loss(51.85±27.14)ml,the operation time(69.39±19.34)min and the transfer rate(0.84%)were lower in the observation group than those in the control group(82.67±36.29)ml,(119.44±23.73)min and(8.82%),the difference was statistically significant(P<0.05).There was no significant difference in the time of first anal exhaust,food time and hospitalization time(P>0.05).The levels of blood white blood cell count(WBC)(4.32±1.14)×109/L,hemoglobin(Hb)(125.37±18.28)g/L and platelet(PLT)were significantly higher than those in the observation group(378.28±112.94)(P<0.05)were significantly higher than those in the control group(3.28±1.05)×109/L,(97.23±22.43)g/L and(239.42±134.82)×109/L,respectively.The incidence of pancreatic fistula,abdominal hemorrhage,portal vein thrombosis,infection and intestinal obstruction was significantly lower in the observation group than in the control group(P<0.05).Conclusion Splenectomy of splenic pedicle in spleen splenectomy can reduce the intraoperative blood loss and transfer rate,reduce the operation time and reduce the incidence of postoperative complications.It can be further promoted in clinical and use.