选择性脾动脉栓塞术治疗外伤性脾破裂的临床研究

金晶; 陶亮

doi:10.16766/j.cnki.issn.1674-4152.002590

选择性脾动脉栓塞术治疗外伤性脾破裂的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002590

金晶^1, ,,
陶亮²

1.
衢州市人民医院普外科，浙江衢州 324000
2.
海宁市中心医院普外科，浙江嘉兴 314400

基金项目:

浙江省医药卫生科技计划项目 2018RC076

详细信息

通讯作者:
金晶, E-mail: 594jj@163.com

中图分类号: R657.62
计量
- 文章访问数: 209
- HTML全文浏览量: 47
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-07

Clinical effect of selective splenic artery embolization in the treatment of traumatic splenic rupture

JIN Jing^{1
, ,},
TAO Liang²

1.
Department of General Surgery, Quzhou People' s Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的评价选择性脾动脉栓塞术用于治疗外伤性脾破裂的有效性和安全性。方法以2017年3月—2020年3月衢州市人民医院诊治的120例外伤性脾破裂患者为研究对象，按照手术方式不同分为对照组(60例)和研究组(60例)。对照组实施腹腔镜下脾脏部分切除术，研究组实施选择性脾动脉栓塞术。记录患者手术时间、术中出血量、引流管留置时间、术后肛门首次排气时间、术后首次下床时间和住院时间等手术治疗指标，检测患者手术前后外周血IgM、IgA和IgG水平，观察患者并发症情况。结果研究组患者手术时间、术中出血量、引流管留置时间、术后肛门首次排气时间、术后首次下床时间和住院时间[(94.73±10.62)min，(196.49±24.62)mL，(2.25±0.36)d，(2.65±0.39)d，(2.84±0.41)d和(5.29±0.61)d]均显著少于对照组[(128.52±12.03)min，(339.62±40.81)mL，(3.57±0.49)d，(3.86±0.51)d，(3.91±0.54)d和(7.46±0.82)d，均P < 0.05]；术前和术后3个月，2组患者外周血IgM、IgA和IgG比较差异无统计学意义(均P>0.05)；研究组患者围术期并发症总发生率(6.67%)显著低于对照组(21.67%，χ²=5.551，P=0.018)。结论选择性脾动脉栓塞术可有效减轻外伤性脾破裂患者手术创伤，缩短术后康复周期，对患者免疫功能影响较小，降低术后并发症发生风险。
- 外伤性脾破裂 /
- 脾脏部分切除术 /
- 选择性脾动脉栓塞术 /
- 康复周期 /
- 免疫功能 /
- 并发症
Abstract: Objective To evaluate the efficacy and safety of selective splenic artery embolization in the treatment of traumatic splenic rupture. Methods A total of 120 patients with traumatic splenic rupture in Quzhou People ' s Hospital from March 2017 to March 2020 were selected. They were divided into control group (60 cases) and study group (60 cases) in accordance with different operation methods. Laparoscopic partial splenectomy was performed in the control group and selective splenic artery embolization was performed in the study group. The operation time, intraoperative blood loss, indwelling time of drainage tube, first postoperative anal exhaust time, first postoperative ambulation time and hospitalisation time were recorded. The levels of IgM, IgA, IgG and other immune factors in peripheral blood before and after operation were detected. The complications within 12 months after operation were followed up. Results The operation time, intraoperative bleeding, indwelling time of drainage tube, first exhaust time of anus after operation, first time out of bed and hospital stay after operation in the study group [(94.73±10.62) min, (196.49±24.62) mL, (2.25±0.36) d, (2.65±0.39) d, (2.84±0.41) d and (5.29±0.61) d, respectively] were significantly less than those in the control group [(128.52±12.03) min, (339.62±40.81) mL, (3.57±0.49) d, (3.86±0.51) d, (3.91±0.54) d and (7.46±0.82) d, respectively, all P < 0.05]. No significant difference was found in the levels of IgM, IgA and IgG between the two groups before and 3 months after operation (all P>0.05). The overall incidence of postoperative complications in the study group (6.67%) was significantly lower than that in the control group (21.67%, χ²=5.551, P=0.018). Conclusion Selective splenic artery embolization could effectively reduce the surgical trauma of patients with traumatic splenic rupture, shorten the postoperative rehabilitation cycle, less affect the immune function of patients and reduce the risk of postoperative complications.
- Traumatic rupture of spleen /
- Partial splenectomy /
- Selective splenic artery embolization /
- Rehabilitation cycle /
- Immunity /
- Complication
利益冲突 无

HTML全文

表 1 2组外伤性脾破裂患者手术治疗指标比较(x±s)

Table 1. Comparison of surgical treatment indexes between two groups of patients with traumatic splenic rupture(x±s)

组别	例数	手术时间(min)	术中出血量(mL)	引流管留置时间(d)	术后肛门首次排气时间(d)	术后首次下床时间(d)	住院时间(d)
对照组	60	128.52±12.03	339.62±40.81	3.57±0.49	3.86±0.51	3.91±0.54	7.46±0.82
研究组	60	94.73±10.62	196.49±24.62	2.25±0.36	2.65±0.39	2.84±0.41	5.29±0.61
t值		16.245	23.225	17.067	14.487	12.123	16.412
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 2 2组外伤性脾破裂患者手术前后免疫学指标情况比较(x±s，g/L)

Table 2. Comparison of immunological indexes before and after operation between two groups of patients with traumatic splenic rupture(x±s, g/L)

组别	例数	IgM		IgA		IgG
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
对照组	60	2.34±0.47	2.19±0.45	2.63±0.40	2.51±0.37	12.54±1.42	12.39±1.35
研究组	60	2.39±0.49	2.23±0.41	2.67±0.43	2.49±0.39	12.69±1.45	12.17±1.40
t值		0.588	0.528	0.568	0.240	0.570	0.868
P值		0.558	0.599	0.571	0.811	0.569	0.387

下载: 导出CSV

表 3 2组外伤性脾破裂患者围术期并发症情况比较[例(%)]

Table 3. Comparison of perioperative complications in patients with traumatic splenic rupture between two groups [cases (%)]

组别	例数	胰瘘	脾蒂出血	脾热	切口感染	总发生
对照组	60	3(5.00)	5(8.33)	3(5.00)	2(3.33)	13(21.67)
研究组	60	1(1.67)	2(3.33)	1(1.67)	0	4(6.67)
注：2组患者围术期并发症总发生率比较，χ²=5.551，P=0.018。

下载: 导出CSV

参考文献(20)

[1]	黄景祥, 汤广恩. 外伤性脾破裂治疗方案影响因素的研究分析[J]. 现代诊断与治疗, 2017, 28(15): 2893-2895. doi: 10.3969/j.issn.1001-8174.2017.15.093 HUANG J X, TANG G E. Analysis of influencing factors of treatment plan for traumatic splenic rupture[J]. Modern Diagnosis and Treatment, 2017, 28(15): 2893-2895. doi: 10.3969/j.issn.1001-8174.2017.15.093
[2]	李世佳. 腹腔镜脾切除术与开腹脾切除术治疗外伤性脾破裂的临床对比[J]. 中国伤残医学, 2020, 28(6): 48-49. https://cdmd.cnki.com.cn/Article/CDMD-10183-1015591788.htm LI S J. Clinical comparison of laparoscopic splenectomy and open splenectomy for traumatic splenic rupture[J]. Chinese Journal of Trauma and Disability Medicine, 2020, 28(6): 48-49. https://cdmd.cnki.com.cn/Article/CDMD-10183-1015591788.htm
[3]	张峰, 姜洪池, 乔海泉, 等. 脾脏损伤的临床分级[J]. 中华肝胆外科杂志, 1998, 4(2): 99-100. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHGD199802019.htm ZHANG F, JIANG H C, QIAO H Q. Clinical classification of splenic injury[J]. Journal of Hepatobiliary Surgery, 1998, 4(2): 99-100. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHGD199802019.htm
[4]	叶广坡, 项和平, 李贺, 等. 外伤性脾破裂的外科诊治进展[J]. 中国临床保健杂志, 2017, 20(6): 762-765. doi: 10.3969/J.issn.1672-6790.2017.06.039 YE G P, XIANG H P, LI H, et al. Progress of diagnosis and surgical treatment of traumatic spleen rupture[J]. Chinese Journal of Clinical Healthcare, 2017, 20(6): 762-765. doi: 10.3969/J.issn.1672-6790.2017.06.039
[5]	冯业鹏. 外伤性脾破裂的治疗体会研究[J]. 中国农村卫生, 2020, 12(3): 39, 41. https://www.cnki.com.cn/Article/CJFDTOTAL-NCWS202003023.htm FENG Y P. Study on the treatment of traumatic rupture of spleen[J]. China Rural Health, 2020, 12(3): 39, 41. https://www.cnki.com.cn/Article/CJFDTOTAL-NCWS202003023.htm
[6]	叶广坡, 项和平, 李贺, 等. 外伤性脾破裂的外科诊治进展[J]. 中国临床保健杂志, 2017, 20(6): 762-765. doi: 10.3969/J.issn.1672-6790.2017.06.039 YE G P, XIANG H P, LI H, et al. Progress of diagnosis and surgical treatment of traumatic spleen rupture[J]. Chinese Journal of Clinical Healthcare, 2017, 20(6): 762-765. doi: 10.3969/J.issn.1672-6790.2017.06.039
[7]	吉木伍里. 损伤控制理念在肝脾破裂急诊手术中应用效果分析[J]. 中华普外科手术学杂志(电子版), 2017, 11(3): 244-247. doi: 10.3877/cma.j.issn.1674-3946.2017.03.020 JIMU W L. The effect and value of damage control concept on emergency operation in the liver and spleen rupture[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2017, 11(3): 244-247. doi: 10.3877/cma.j.issn.1674-3946.2017.03.020
[8]	马建中, 张宇, 韩圣瑾, 等. 脾全切除术与脾部分切除术治疗外伤性脾破裂的临床疗效对比[J]. 现代生物医学进展, 2017, 17(24): 4706-4709, 4734. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201724026.htm MA J Z, ZHANG Y, HAN S J, et al. Comparison of clinical efficacy between spleen total resection and spleen partial splenectomy in treatment of traumatic spleen rupture[J]. Progress in Modern Biomedicine, 2017, 17(24): 4706-4709, 4734. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201724026.htm
[9]	曾国祥, 邬善敏, 王柏林, 等. PSE治疗外伤性脾破裂临床疗效及对患者机体免疫功能的影响[J]. 中国现代医生, 2017, 55(24): 15-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201724005.htm ZENG G X, WU S M, WANG B L, et al. Clinical efficacy of PSE in the treatment of traumatic splenic rupture and its effect on the immune function in patients[J]. China Modern Doctor, 2017, 55(24): 15-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201724005.htm
[10]	邓昌林, 邹宏文, 李小娇, 等. 外伤性脾破裂患者治疗策略的影响因素分析[J]. 中华普通外科杂志, 2017, 32(11): 937-940. DENG C L, ZOU H W, LI X J, et al. Traumatic splenic rupture, conservative vs surgical therapy[J]. Chinese Journal of General Surgery, 2017, 32(11): 937-940.
[11]	杨燕茹, 王琳, 吴安琪. 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[J]. 中华全科医学, 2021, 19(1): 35-37, 58. doi: 10.16766/j.cnki.issn.1674-4152.001723 YANG Y R, WANG L, WU A Q. Clinical effect and value of laparoscopic guided secondary spleen pedicle transection in patients with traumatic spleen injury[J]. Chinese Journal of General Practice, 2021, 19(1): 35-37, 58. doi: 10.16766/j.cnki.issn.1674-4152.001723
[12]	陈晶, 张悦, 杨雨, 等. 程序化腹腔镜脾切除或脾部分切除术在创伤性脾破裂诊治中的应用[J]. 中华普通外科杂志, 2018, 33(10): 878-879. CHEN J, ZHANG Y YANG Y, et al. Application of programmed laparoscopic splenectomy or partial splenectomy in the diagnosis and treatment of traumatic splenic rupture[J]. Chinese Journal of General Surgery, 2018, 33(10): 878-879.
[13]	周志涛, 范隼, 何伟良, 等. 腹腔镜脾切除术在外伤性脾破裂中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2019, 8(6): 522-526. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZW201906013.htm ZHOU Z T, FAN S, HE W L, et al. Application value of laparoscopic splenectomy in traumatic splenic rupture[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 8(6): 522-526. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZW201906013.htm
[14]	申琳. 外伤性脾破裂脾动脉介入栓塞术的临床效果[J]. 河南外科学杂志, 2021, 27(2): 100-101. https://www.cnki.com.cn/Article/CJFDTOTAL-HLWK202102044.htm SHEN L. Clinical effect of splenic artery interventional embolization in traumatic splenic rupture[J]. Henan Journal of Surgery, 2021, 27(2): 100-101. https://www.cnki.com.cn/Article/CJFDTOTAL-HLWK202102044.htm
[15]	卢骏, 夏婷, 李磊, 等. 脾动脉介入栓塞治疗外伤性脾破裂的临床效果及对患者免疫功能的影响[J]. 现代生物医学进展, 2019, 19(10): 1937-1940, 1952. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201910028.htm LU J, XIA T, LI L, et al. Clinical Efficacy of Splenic Artery interventional embolization in the treatment of traumatic splenic rupture and its influence on the immune function[J]. Progress in Modern Biomedicine, 2019, 19(10): 1937-1940, 1952. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX201910028.htm
[16]	吴瑞克, 陈新国, 李霞. 选择性脾动脉栓塞术治疗创伤性脾破裂伴休克的疗效分析[J]. 浙江创伤外科, 2019, 24(3): 472-473. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJCW201903022.htm WU R K, CHEN X G, LI X. Selective splenic artery embolization in the treatment of traumatic splenic rupture with shock[J]. Zhejiang Journal of Traumatic Surgery, 2019, 24(3): 472-473. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJCW201903022.htm
[17]	张雄杰, 毛艳平. 全脾切除术与部分脾切除术对门静脉高压症脾功能亢进患者免疫功能影响的比较[J]. 中华普外科手术学杂志(电子版), 2018, 12(5): 411-413. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHPW201805017.htm ZHANG X J, MAO Y P. The comparison of immune function after splenectomy and partial splenectomy in patients with portal hypertension and hypersplenism[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(5): 411-413. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHPW201805017.htm
[18]	汪海洋, 陈树军, 刘汝斌. 脾破裂经脾切除治疗后加行大网膜自体脾片种植的临床疗效[J]. 中国医科大学学报, 2018, 47(1): 53-57. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201801013.htm WANG H Y, CHEN S J, LIU R B. Efficacy of omental implantation of autologous splenic segments after splenectomy for traumatic rupture[J]. Journal of China Medical University, 2018, 47(1): 53-57. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201801013.htm
[19]	牟奇海, 彭科, 邱远, 等. 选择性脾动脉栓塞术对急诊外伤性脾破裂救治的效果探讨[J]. 局解手术学杂志, 2020, 29(5): 410-413. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202005016.htm MOU Q H, PENG K QIU Y, et al. Effect of selective splenic artery embolization on emergency treatment of traumatic splenic rupture[J]. Journal of Regional Anatomy and Operative Surgery, 2020, 29(5): 410-413. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202005016.htm
[20]	戴东华, 万冬冬. 脾动脉介入栓塞与脾切除术治疗创伤性脾破裂的临床疗效[J]. 中外医疗, 2021, 40(27): 191-194. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ202127047.htm DAI D H, WAN D D. The clinical effect of splenic artery embolization and splenectomy in the treatment of traumatic splenic rupture[J]. China & Foreign Medical Treatment, 2021, 40(27): 191-194. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ202127047.htm