脾修补术、部分切除术及动脉栓塞术治疗创伤性脾破裂的疗效以及对患者免疫功能的影响

Influence of splenic repair,partial splenectomy and splenic artery embolization on immune function in patients with traumatic splenic rupture

目的探讨对比脾修补术、部分切除术及动脉栓塞术治疗创伤性脾破裂的疗效及对患者免疫功能的影响。方法回顾性分析2015年1月—2018年12月海南医学院第一附属医院普外科收治的160例创伤性脾破裂患者,男性84例,女性76例;年龄37~68岁,平均45.86岁。其中50例行脾修补术(修补组),55例行脾部分切除术(切除组),55例行脾动脉栓塞术(栓塞组)。对三组患者的手术情况、手术疗效及手术前后外周血T淋巴细胞变化进行对比、分析。结果栓塞组的手术时间为(116.42±34.37)min,显著低于另外两组的(224.36±42.58)min和(218.74±36.04)min;栓塞组的术后住院时间为(7.85±1.30)d,显著低于另外两组的(10.36±2.74)d和(11.09±3.14)d;栓塞组的术中输血量为(205.80±46.68)mL,显著少于另外两组的(576.32±51.74)mL和(560.68±49.92)mL(P<0.05)。三组的手术总有效率分别为94%、87%和95%,组间比较差异无统计学意义(P>0.05)。与术前相比,三组术后2周的CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平均明显降低,术后4周较术后2周有所提高。栓塞组术后4周的CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平分别为(60.95±3.77)%、(36.07±4.45)%、(1.21±0.14)%、(11.20±1.84)g/L、(1.59±0.36)g/L、(0.96±0.27)g/L,均与术前对应值接近,但均显著高于另外两组对应值(P<0.05);栓塞组术后2周CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平分别为(50.96±2.14)%、(32.20±3.17)%、(1.09±0.07)%、(9.05±1.66)g/L、(1.21±0.35)g/L、(0.82±0.23)g/L。栓塞组术后并发症总发生率为7%,显著低于修补组(24%)和切除组(20%),P<0.05。结论脾修补术、部分切除术和动脉栓塞术治疗创伤性脾破裂均有较好的效果,其中脾动脉栓塞术的操作更简单、创伤更小、并发症更少、免疫功能恢复更快,应用优势更显著。

Objective To compare the efficacy of splenic repair,partial splenectomy and splenic artery embolization in the treatment of traumatic splenic rupture and the effect on immune function of patients.Methods A retrospective analysis was conducted in 160 patients with traumatic spleen rupture admitted to the Department of General Surgery of the First Affiliated Hospital of Hainan Medical College from Jan.2015 to Dec.2018.There were 84 males and 76 females;their age ranged from 37 to 68 years,with an average age of 45.86 year.Among the 160 patients,50 of them underwent splenic repair(repair group),55 underwent partial splenectomy(resection group),and 55 underwent splenic artery embolization(embolization group).The operative condition,curative effect and changes of T lymphocyte in peripheral blood of the three groups were retrospectively compared and analyzed.Results The operation time of the embolization group was(116.42±34.37)minutes,significantly shorter than that of the other two groups(224.36±42.58)minutes and(218.74±36.04)minutes;the postoperative hospitalization time of the embolization group was(7.85±1.30)days,significantly shorter than that of the other two groups(10.36±2.74)days and(11.09±3.14)days;the intraoperative blood transfusion volume of the embolization group was(205.80±46.68)mL,significantly less than that of the other two groups(576.32±51.74)mL and(560.68±49.92)mL(P<0.05).The total effective rates of the three groups were 94%,87%and 95%,respectively,without significant difference among the three groups(P>0.05).Compared with before operation,the levels of CD3^+,CD4^+,CD4^+/CD8^+,IgG,IgA and IgM in the three groups were significantly lower at 2 weeks after operation,and the levels of CD3^+,CD4^+,CD4^+/CD8^+,IgG,IgA and IgM four weeks after operation were higher than those of two weeks after operation.The levels of CD3^+,CD4^+,CD4^+/CD8^+,IgG,IgA and IgM were(60.95±3.77)%,(36.07±4.45)%,(1.21±0.14)%,(11.20±1.84)g/L,(1.59±0.36)g/L,and(0.96±0.27)g/L,respectively,which were close to the corresponding values before operation,but significantly higher than the corresponding values of the other two groups(P<0.05).The levels of CD3^+,CD4^+,CD4^+/CD8^+,IgG,IgA and IgM were(50.96±2.14)%,(32.20±3.17)%,(1.09±0.07)%,(9.05±1.66)g/L,(1.21±0.35)g/L and(0.82±0.23)g/L in the embolization group 2 weeks after operation.The total incidence of postoperative complications in the embolization group was 7%,significantly lower than that in the repair group(24%)and the resection group(20%),P<0.05.Conclusion Splenic repair,partial splenectomy and splenic artery embolization are all effective in the treatment of traumatic splenic rupture.Splenic artery embolization has advantages such as simpler operation,less trauma,fewer complications,and faster immune function recovery,which has significant application value.