手助腹腔镜脾切除术治疗创伤性脾破裂临床分析

Clinical analysis of hand-assisted laparoscopic splenectomy for traumatic splenic rupture

目的分析比较手助腹腔镜脾切除术与开腹脾切除术治疗创伤性脾破裂的临床疗效。方法回顾性分析2014年10月—2017年8月南昌大学第一附属医院收治的33例创伤性脾破裂患者的手术情况与病例资料,其中手助腹腔镜组19例,采用手助腹腔镜脾切除术,男性16例,女性3例;平均年龄(39. 9±15. 7)岁;道路交通伤15例,挤压伤4例。传统手术组14例,采用开腹脾切除术治疗,男性8例,女性6例;平均年龄(43. 2±14. 8)岁;道路交通伤9例,挤压伤4例,刀刺伤1例。对比两组手术时间、术中失血量、术后肛门开始排气时间、术后镇痛药物使用率、住院时间、住院费用以及手术并发症发生率。结果 33例患者全部顺利完成手术,手助腹腔镜组无一例中转开腹。两组手术时间、术中失血量、住院费用差异无统计学意义,而手助腹腔镜组住院天数(10. 2±2. 6) d、术后排气时间(1. 8±0. 6) d、术后镇痛药物使用率21. 1%以及手术并发症发生率0优于传统手术组(13. 6±4. 2) d、(2. 3±0. 5) d、64. 3%、35. 7%(P <0. 05)。结论手助腹腔镜脾切除术治疗创伤性脾破裂是一种安全、有效的手术方式,值得推广应用。

Objective To analyze and compare the clinical effects of hand-assisted laparoscopic splenectomy(HALS)and open splenectomy(OS)for traumatic splenic rupture.Methods Retrospective analysis was conducted in the surgical status and case data of33patients with traumatic spleen rupture who were admitted into the First Affiliated Hospital of Nanchang University from Oct.2014to Aug.2017.Among them,19cases were treated by hand-assisted laparoscopic splenectomy,including16males and3females with an average age of(39.9±15.7)years.There were15cases of traffic accident injuries and4cases of crush injuries.Fourteen cases were treated by open splenectomy,including8males and6females,with an average age of(43.2±14.8)years.There were9cases of traffic accident injuries,4cases of crush injuries,and1case of knife stab injury.The operation time,intraoperative blood loss,postoperative ventilation time,postoperative analgesic drug use rate,hospitalization time,hospitalization cost,and surgical complication rate were compared between the two groups.Results All the33patients underwent surgery successfully.No patient of the hand-assisted laparoscopic splenectomy was converted to open surgery.There was no significant difference in the operation time,intraoperative blood loss and hospitalization cost between the two groups.In the hand-assisted laparoscopic splenectomy group,the length of hospitalization((10.2±2.6)days),postoperative ventilation time((1.8±0.6)days),postoperative analgesic drugs use rate(21.1%)and surgical complication rate(0)were better than those in the traditional surgery group((13.6±4.2)d,(2.3±0.5)d,64.3%,35.7%,respectively(P<0.05).Conclusion Compared with open splenectomy,hand-assisted laparoscopic splenectomy for the treatment of traumatic rupture of the spleen is safer and more effective,which is worth to be promoted in the clinical application.