腹腔镜微创术与开放术式对创伤性脾破裂患者术后凝血系统和免疫系统的影响

Effects of laparoscopic minimally invasive surgery and open surgery on postoperative coagulation system and immune system in patients with traumatic spleen rupture

目的探讨腹腔镜微创术与开放术式对创伤性脾破裂患者术后凝血系统和免疫系统的影响。方法选取2017年5月至2019年5月本院收治的80例创伤性脾破裂患者,并根据手术方案的不同分为微创组(n=37)和开放组(n=43)。微创组采用腹腔镜微创术治疗,开放组采用开放术式治疗;统计两组患者的手术时间、出血量、引流量以及住院时间;比较两组患者治疗前、后凝血酶原时间(PT)、凝血酶时间(TT)以及活化部分凝血活酶时间(APTT)变化;比较两组患者治疗前、后免疫球蛋白A(IgA)、免疫球蛋白G(IgG)以及免疫球蛋白M(IgM)水平变化;统计两组患者并发症总发生率。结果开放组手术时间和住院时间均长于微创组,差异有统计学意义(P<0.05);开放组出血量和引流量均高于微创组,差异有统计学意义(P<0.05);治疗后,开放组PT、TT和APTT均高于微创组,差异有统计学意义(P<0.05);治疗后,开放组IgA、IgG和IgM三项免疫功能指标表达水平均低于微创组,差异有统计学意义(P<0.05);开放组并发症总发生率为30.23%,高于微创组的10.81%,差异有统计学意义(P<0.05)。结论腹腔镜微创术治疗创伤性脾破裂能显著缩短手术时间和住院时间,减少出血量和引流量,促进免疫系统恢复,并发症少。

Objective To investigate the effects of laparoscopic minimally invasive surgery and open surgery on postoperative coagulation system and immune system in patients with traumatic spleen rupture.Methods 80 patients with traumatic splenic rupture admitted to our hospital from May 2017 to May 2019 were enrolled.According to different surgical procedures,they were divided into 37 patients with minimally invasive surgery and 43 patients with open surgery.The minimally invasive group was treated with laparoscopic minimally invasive surgery,and the open group was treated with with open surgery,operative time,bleeding volume,drainage volume and hospitalization time were compared between the two groups.Changes inprothrombin time(PT)and enzyme time(TT)and activated partial thromboplastin time(APTT),immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)before and after treatment in both groups were compared.The total incidence of complications in both groups was counted.Results The operation time and hospitalization time of the open group were longer than those of the minimally invasive group,and the difference was statistically significant(P<0.05).The bleeding volume and drainage volume of the open group were lower than those of the minimally invasive group,and the difference was statistically significant(P<0.05).After treatment,the expression levels of PT,TT and APTT in the open group were higher than those in the minimally invasive group(P<0.05).After treatment,the expression levels of IgA,IgG and IgM in the open group were lower than those in the minimally invasive group,the difference was statistically significant(P<0.05).The total incidence of complications in the open group was 30.23%,which was higher than that in the minimally invasive group(10.81%),the difference was statistically significant(P<0.05).Conclusion Laparoscopic minimally invasive surgery for traumatic spleen rupture can significantly shorten the operation time and hospital stay,reduce the amount of bleeding and drainage,promote the recovery of the immune system,and have fewer complications.