保脾性手术治疗脾破裂的临床疗效分析

Clinical Analysis of Spleen Preserving Surgery in the Treatment of Splenic Rupture

【目的】探讨保脾性手术治疗脾破裂的临床疗效。【方法】回顾性2014年1月至2019年8月本院收治的64例外伤性牌破裂患者的临床资料,根据治疗方法的不同将其分为观察组(行脾修复补术,n=31)和对照组(脾部分切除术,n=33)。记录两组患者手术情况,同时检测手术前后CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞水平及血清C反应蛋白(CRP)和肿瘤坏死因子α(TNF-α)水平。【结果】两组患者均顺利完成手术,两组患者手术时间、住院时间、术中出血量和肛门排气时间比较,差异无统计学意义(P>0.05)。术后4周,两组患者CD3^(+)、CD4^(+)T淋巴细胞水平较术前升高,而CD8^(+)T淋巴细胞水平较术前降低,差异有统计学意义(P<0.05);两组患者血清CRP、TNF-α水平高于术前,差异有统计学意义(P<0.05);两组患者术后4周血清CRP、TNF-α水平比较,差异无统计学意义(P>0.05)。观察组术后并发症发生率为6.45%(2/31),对照组并发症发生率为9.09%(3/33),差异比较无统计学意义(χ^(2)=0.155,P=0.694>0.05)。【结论】保脾性手术治疗脾破裂有较好的效果,相较于脾部分切除术,行脾修补术更有助于免疫功能改善。

【Objective】To explore the clinical value of spleen-preserving surgery in the treatment of splenic rupture.[Methods]The clinical data of 64 patients with traumatic splenic rupture admitted to our hospital from January 2014 to August 2019 were retrospectively analyzed.According to different treatment methods,they were divided into observation group(spleen repair,n=31)and control group(partial splenectomy,n=33).The operation conditions of the two groups were recorded,and the levels of CD3^(+),CD4^(+),CD8^(+)T lymphocytes,serum C-reactive protein(CRP)and tumor necrosis factor-a(TNF-a)were detected before and after operation.【Results】There was no significant difference in operation time,hospitalization time,intraoperative blood loss and anal exhaust time between the two groups(P>0.05).At 4 weeks after operation,the levels of CD3^(+)and CD4^(+)T lymphocytes in the two groups were higher than those before operation,while the level of CD8^(+)T lymphocytes was lower than that before operation,and the difference was statistically significant(P〈0.05);The serum levels of CRP and TNF-α in the two groups were significantly higher than those before operation(P<0.05);There was no significant difference in serum CRP and TNF-α levels between the two groups at 4 weeks after operation(P>0.05).The incidence of postoperative complications was 6.45%(2/31)in the observation group and 9.09%(3/33)in the control group,with no significant difference(χ^(2)=0.155,P=0.694〉0.05).【Conclusion】Compared with partial splenectomy,splenic repair is more helpful to improve immune function.