脾脏保留手术对外伤性脾破裂患者免疫功能的影响

Effect of Spleen Preservation Surgery on the Immune Function of Patients with Traumatic Splenic Rupture

目的:探究脾脏保留手术对外伤性脾破裂患者免疫功能的影响。方法:选取2015年8月~2018年9月我院收治的外伤性脾破裂患者83例进行回顾性分析,根据手术方式不同分为两组,对照组(41例)患者给予脾脏切除术,观察组(42例)患者给予脾脏保留手术。比较两组患者的手术时间、术中出血量、下床活动时间、术后1d引流量、抢救成功率及治疗前后CD3^+、CD4^+、CD8^+和Tuftsin因子水平和并发症的发生情况。结果:治疗后,观察组患者的手术时间、术中出血量、术后下床时间和术后1d引流量均显著短于或低于对照组,而救治成功率显著高于对照组(P<0.05)。两组患者治疗后的CD3^+、CD4^+和CD4^+/CD8^+水平均较治疗前显著下降,且观察组以上指标均显著高于对照组(P<0.05)。对照组治疗后血清Tuftsin因子水平较治疗前显著下降,而观察组血清Tuftsin因子水平较治疗前显著升高,并显著高于对照组(P<0.05)。观察组患者的总并发症发生率为7.14%,较对照组(24.39%)显著降低(P<0.05)。结论:与脾脏切除术相比,脾脏保留手术可显著改善外伤性脾破裂患者的免疫功能,且手术效果更好,安全性更高。

Objective: To explore the effect of spleen preservation surgery on immune function in patients with traumatic splenic rupture. Methods: 93 patients with traumatic splenic rupture admitted in our hospital from August 2015 to September 2018 were retrospectively analyzed. According to different surgical methods, they were divided into two groups: the control group(41 cases)received splenectomy, and the observation group(42 cases) received splenic reservation surgery. The operation time, intraoperative blood loss, time to get out of bed, postoperative drainage volume, rescue success rate, the levels of CD3^+, CD4^+, CD8^+, Tuftsin before and after treatment and complications were compared between the two groups. Results: After treatment, the operation time, intraoperative blood loss, time to get out of bed and postoperative drainage volume of patients in the observation group were significantly lower or shorter than those in the control group, but the success rate was significantly higher than that in the control group(P<0.05). After treatment, the levels of CD3^+, CD4^+and CD4^+/CD8^+ in the two groups were significantly lower than those before treatment, but the above indicators in the observation group were significantly higher than those in the control group(P <0.05). The Tuftsin level in the control group was significantly decreased after treatment, while that in the observation group was significantly increased after treatment, and that in the observation group was significantly higher than that in the control group(P<0.05). The total incidence of complications was 7.14% in the observation group, compared with the control group(24.39%), it was significantly lower(P <0.05). Conclusion: Compared with splenectomy, splenic preservation surgery can more effectively improve the immune function of patients with traumatic splenic rupture with higher safety.