腹腔镜与开腹脾切除术治疗创伤性脾破裂的疗效分析

Laparoscopic and Open Splenectomy in Traumatic Splenic Rupture:a Comparative Study

目的探讨腹腔镜与开腹脾切除治疗创伤性脾破裂的临床疗效及应用价值。方法回顾性分析2021年1月至2024年5月上海交通大学附属第六人民医院奉贤分院收治的48例创伤性脾破裂患者的临床资料,其中21例行腹腔镜脾切除术(研究组),27例行传统开腹脾切除术(对照组)。比较2组总手术时间、脾切除时间、术中出血量、术后胃肠功能恢复时间、引流管放置时间、住院时间和术后并发症(术后腹腔出血、肺部感染、胰漏、切口脂肪液化)发生率。结果研究组术后胃肠功能恢复时间、引流管放置时间、住院时间均少于对照组,总手术时间和脾切除时间均多于对照组,差异有统计学意义(均P<0.05)。2组术中出血量和术后并发症发生率比较差异均无统计学意义(均P>0.05)。结论合理掌握手术适应证,腹腔镜脾切除治疗创伤性脾破裂相较于传统开腹手术,具有手术创伤小,术后恢复快,住院时间短等优势,手术安全可靠。

Objective To investigate clinical efficacy and application value of laparoscopic and open splenectomy in the management of traumatic splenic rupture.Methods The clinical data of 48 patients with traumatic splenic rupture admitted to the Department of General Surgery of our hospital from January 2021 to May 2024 were retrospectively analyzed;21 patients underwent laparoscopic splenectomy(study group)and 27 underwent traditional open splenectomy(control group).Total operation time,splenectomy time,intraoperative blood loss,postoperative gastrointestinal function recovery time,drainage tube placement time,hospitalization days,postoperative complications(postoperative abdominal bleeding,pulmonary infection,pancreatic leakage,incision fat liquefaction)were compared between the two groups.Results Postoperative gastrointestinal function recovery time,drainage tube placement time,and hospitalization days in the study group were less than those in the control group,and the differences were statistically significant(all P<0.05).The differences in intraoperative bleeding and postoperative complication rates were not statistically significant between the 2 groups(both P>0.05).Conclusions Given reasonable indications for surgery,laparoscopic splenectomy in the management of traumatic splenic rupture has the advantages of less surgical trauma,quicker postoperative recovery,shorter hospitalization time,with reliable safety profile,compared with the traditional open splenectomy.