不同方法脾蒂离断脾切除术的临床分析  

Comparison of the Clinical Analysis of the Different Spleen Pedicle Severance for Splenectomy

作　　者：蒋雪峰[1] 肖宝来[1] 岳信[1] 邓清[1] 田夫[1] 

机构地区：[1]湖北省荆州市第一人民医院胃肠外科,荆州434000

出　　处：《中国现代手术学杂志》2011年第5期352-354,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨二级脾蒂离断术在门静脉高压病人脾切除术中的作用。方法肝硬化门静脉高压脾肿大脾亢患者行脾切除加贲门周围血管离断术治疗共96例,其中行二级脾蒂离断术组52例(离断组,n=52),传统脾蒂离断脾切除术组44例(传统组,n=44)。其中离断组在处理脾蒂时采用二级脾蒂离断法,传统组则采用一级脾蒂离断法。回顾性比较两组的手术相关指标,术后并发症及死亡率。结果传统组手术时间平均为(158.35±40.32)min,与离断组的(161.56±38.57)min无明显差异。两组死亡各1例,均为Child C级患者,术后并发MSOF所致。离断组的脾热和胰漏的发生率分别为13.5%(7/52)和0,传统组分别为31.8%(4/44)和11.4%(5/44),二者差异显著(P<0.05),且传统组脾热的持续时间为(14.50±7.23)d,明显长于离断组的(2.40±1.14)d(P<0.01);其他并发症(膈下积液、门静脉血栓形成、MSOF)发生率及死亡率两组无明显差异(P>0.05)。结论二级脾蒂离断术可降低门静脉高压脾切除病人脾热、胰漏的发生率,且不延长手术时间,是一种值得推广的手术方式,尤其对于脾脏较大的病人更为适合。Objective To evaluate the value of the technique of spleen subpedicle severance for splenectomy in portal hypertension patients.Methods 96 cases of portal hypertension underwent pericardiac devascularization plus splenectomy were randomly divided into two groups.In 44 cases of Group A,the traditional technique was used to break spleen pedicle down,and in 52 cases of Group B,a neo-technique was used for the spleen subpedicle severance.The operation time,the complication rates and mortality rates were compared between these two groups.Results There was no significant difference in the operation time,which was（158.35±40.32）min of Group A and（161.56±38.57）min of Group B.The mortality rate was 2.3%（1/44） and 1.9%（1/52） of Group A and B without statistical difference.But it showed significant differences in the rates of spleen fever（31.8% vs.13.5%） and pancreas leakage（11.4% vs.0） in Group A and B（P0.05）.And the duration of the spleen fever in Group A was（14.50±7.23） days,which was much longer than（2.40±1.14） days in Group B（P0.01）.The rates of the other complications,such as subdiaphragmatic hydrops,pylethrombosis and MSOF,showed no significant difference（P0.05）.Conclusion The technique of spleen subpedicle severance can decrease incidence rates of the spleen fever and the pancreas leakage in portal hypertension patients with splenectomy and pericardiac devascularization.It is a valuable operation technique especially for patients with large spleen.

关 键 词：脾切除术 高血压 门静脉 

分 类 号：R657.6[医药卫生—外科学]