脾切除术联合大网膜自体脾片种植在外伤性脾破裂中的应用效果分析

Analysis on the Application Effect of Splenectomy Combined with Splenic Autotransplantation in the Treatment of Traumatic Rupture of Spleen

目的探讨分析脾切除术联合大网膜自体脾片种植在外伤性脾破裂中的应用效果。方法选取2016年3月至2020年3月汝州市第一人民医院收治的48例外伤性脾破裂患者作为研究对象,并按照随机数表法将其随机分为研究组与对照组,每组24例,对照组患者单纯行脾切除术治疗,研究组患者在对照组治疗的基础上联合应用大网膜自体脾片种植,对比两组患者术后感染发生情况、脾片成活情况以及血小板计数(PLT)、免疫球蛋白(Ig) A、IgG、IgM变化情况。结果术后,研究组患者中发生感染者1例,感染率为4.17%,明显低于对照组患者中发生感染者7例,感染率29.17%(χ^(2)=5.400,P=0.020);术后2周,研究组患者中脾片成活23例,成活率为95.83%;术后,两组患者PLT水平均呈先升高后降低的趋势,IgA、IgG、IgM水平均呈先降低后升高的趋势,但术后第7天,对照组患者PLT水平更高,IgA、IgG、IgM水平更低(t=2.141、3.720、3.710、3.593,P=0. 038、0.001、0.001、0.001),术后第14、28天,研究组患者PLT水平更低,IgA、IgG、IgM水平更高(14 d:t=3.693、2.091、2.485、2.063,P=0.001、0.042、0.017、0.045;28 d:t=3.438、2.273、2.268、2.303,P=0.001、0.028、0.028、0.026)。结论外伤性脾破裂脾切除术后加行大网膜自体脾片种植,脾片易于成活,且能够显著促进患者的免疫功能恢复,降低术后感染发生率,疗效显著。

Objective To explore the application effect of splenectomy combined with splenic autotransplantation on the great omentum in the treatment of traumatic rupture of spleen.Methods Forty-eight patients with traumatic spleen rupture admitted into The First People’s Hospital of Ruzhou from March 2016 to March 2020 were selected as subjects and divided into a study group and a control group according to the random number table,24 patients each group.Patients in the control group were treated with splenectomy only,while patients in the study group were given the implantation of splenic fragments on the great omentum combined with splenectomy.The occurrence of postoperative infection,survival condition of splenic fragments,blood platelet(PLT)count,and changes of immune globulin(Ig)A,IgG and IgM were compared between the two groups.Results After the operation,one patient in the study group developed infection and the infection rate was 4.17%,which was significantly lower than seven patients with infection and 29.17% of infection rate in the control group(χ^(2)=5.400,P=0.020).Two weeks after the operation,splenic fragments were viable in 23 patients in the study group and the survival rate was 95.83%.After the operation,the levels of PLT both presented a trend of first increase and then decrease in the two groups,while the levels of IgA,IgG and IgM presented a trend of first decrease and then increase,but on day 7 after the operation,the level of PLT was much higher and the levels of IgA,IgG and IgM were much lower in the control group as compared with the study group(t=2.141,3.720,3.710 and 3.593,P=0.038,0.001,0.001 and0.001);on day 14 and 28 after the operation,the levels of PLT were much lower and the levels of IgA,IgG and IgM were much higher in the study group as compared with the control group(14 d:t=3.693,2.091,2.485 and 2.063,P=0.001,0.042,0.017 and 0.045;28 d:t=3.438,2.273,2.268 and 2.303,P=0.001,0.028,0.028 and 0.026).Conclusion Performing splenic autotransplantation on the great omentum after splenectomy in the treatment of traumatic rupture of spleen is beneficial for the survival of splenic fragments,and can promote the restoration of immune functions of such patients and decrease the occurrence of postoperative infection,realizing significant curative effect.