腹腔镜引导二级脾蒂离断切脾术在创伤性脾损伤患者中的临床效果和价值

杨燕茹; 王琳; 吴安琪

doi:10.16766/j.cnki.issn.1674-4152.001723

腹腔镜引导二级脾蒂离断切脾术在创伤性脾损伤患者中的临床效果和价值

doi: 10.16766/j.cnki.issn.1674-4152.001723

1.
空军军医大学第一附属医院外科手术室，陕西西安 710000
2.
空军军医大学第一附属医院肝胆胰脾外科，陕西西安 710000

基金项目:

陕西省重点研发计划 2018ZDXM-SF-061

详细信息

通讯作者:
吴安琪, E-mail: dongjingdongleng@sina.com

中图分类号: R657.62 R616.5
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- 文章访问数: 159
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-11
- 网络出版日期: 2022-02-19

Clinical effect and value of laparoscopic guided secondary spleen pedicle transection in patients with traumatic spleen injury

YANG Yan-ru¹,
WANG Lin²,
WU An-qi^{1
, ,}

1.
Surgical Operating Room, The First Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000

摘要

摘要: 目的探讨与研究腹腔镜引导二级脾蒂离断切脾术在创伤性脾损伤患者中的临床效果和价值，旨在为临床治疗此类疾病提供参考依据。方法研究对象为空军军医大学第一附属医院2016年5月—2019年5月期间收治的创伤性脾破裂患者共54例，依据患者手术方式不同分为观察组和对照组，每组27例。对照组应用常规开腹脾切除手术治疗，观察组应用腹腔镜引导下二级脾蒂离断切脾术治疗。记录并分析2组患者平均手术时间、引流管留置时间、术中出血量、术后排气时间、平均住院时间等围手术期指标，术后短期和随访一年并发症发生情况，出院前应用本科室现行的患者满意度调查表对治疗满意度进行调查分析。结果观察组手术时间略长于对照组，差异有统计学意义(P＜0.05)；观察组平均出血量、引流管留置、术后排气及住院时间明显较对照组缩短，差异有统计学意义(均P＜0.05)；观察组术后短期和随访一年并发症发生率明显低于对照组患者，差异有统计学意义(均P＜0.05)；观察组治疗总满意度显著高于对照组，差异有统计学意义(P＜0.05)。结论创伤性脾损伤患者临床应用腹腔镜引导二级脾蒂离断切脾术治疗，与常规开腹手术治疗相比，具有较优的临床效果，不但能够大大降低术中出血量、引流时间、术后排气时间和住院时间等围手术期指标，还能减少术后短期和长期并发症发生，患者满意度高，值得在临床应用推广。
- 创伤性脾损伤 /
- 腹腔镜 /
- 二级脾蒂离断切脾术
Abstract: Objective To explore the clinical effect and value of laparoscopic guided secondary spleen pedicle transection in patients with traumatic spleen injury and to provide reference for clinical treatment of this kind of disease. Methods A total of 54 cases of traumatic splenic rupture in our hospital from May 2016 to May 2019 were selected as subjects and divided into the observation group and control group on the basis of the operation mode (27 cases in each group). The control group was treated with conventional laparotomy, whereas the observation group was treated with laparoscopy-guided secondary spleen pedicle transection. The average operation time, drainage tube indwelling time, intraoperative blood loss, postoperative exhaust time, average hospital stay, the incidence of complications in the short-term and one-year follow-up were recorded and analysed. Before discharge, treatment satisfaction was analysed by the current patient satisfaction questionnaire in the undergraduate department. Results The average operation time in the observation group of perioperative indicators was longer than that in the control group. The difference was statistically significant (P < 0.05). The average intraoperative blood loss, drainage tube indwelling time and postoperative exhaust time in the observation group were significantly shorter than those in the control group, which had statistically significant differences (all P < 0.05). The incidence of complications in the short-term postoperative and 1 year postoperative follow-up was significantly lower in the observation group than that in the control group, which had statistically significant differences (all P < 0.05). The total clinical treatment satisfaction of the observation group was higher than that of the control group, and the difference was significant (P < 0.05). Conclusion Compared with conventional open surgery, traumatic splenic injury in patients with laparoscopic guided secondary spleen pedicle transection has a better clinical effect. It significantly reduces intraoperative blood loss, drainage time, postoperative exhaust time, length of hospital stay, perioperative indicators, and postoperative complications and improves patient satisfaction, which is worth popularizing in clinical application.
- Traumatic spleen injury /
- Laparoscope /
- secondary spleen pedicle transection

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表 1 2组创伤性脾损伤患者手术指标和住院时间比较(x±s)

组别	例数	术中出血(mL)	引流留置时间(d)	排气时间(h)	手术时间(min)	住院时间(d)
观察组	27	208.56±72.64	4.2±2.4	23.45±6.1	116.95±41.97	8.5±2.2
对照组	27	268.56±84.34	6.3±2.7	29.53±6.7	88.84±31.94	13.7±2.5
t值		2.801	3.021	3.487	2.769	8.114
P值		0.007	0.004	0.001	0.008	0.001

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表 2 2组创伤性脾损伤患者术后短期及随访1年并发症比较(例)

组别	例数	术后短期并发症				随访并发症
组别	例数	高淀粉酶血症	发热	腹腔积液	总发生[例(%)]	腹腔感染	肠梗阻	门静脉血栓	总发生[例(%)]
观察组	27	1	1	0	2(7.41)	1	1	0	2(7.41)
对照组	27	3	6	1	10(37.04)	3	3	2	8(29.63)
χ²值					6.857				4.418
P值					0.009				0.036

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表 3 2组创伤性脾损伤患者治疗满意度比较(例)

组别	例数	非常满意	满意	不满意	总满意度(%)
观察组	27	19	6	2	92.59
对照组	27	8	10	9	66.67
注：2组总满意度比较，χ²=5.594, P=0.018。

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