两种脾蒂分离方法在门脉高压患者腹腔镜脾切除术中的应用价值比较  

Comparison of the application value of two kinds of splenic pedicle separation methods in laparoscopic splenectomy for patients with portal hypertension

作　　者：钱军[1] 王李华[1] 林水泉[1] 吕杨波[1] 

机构地区：[1]衢州市人民医院普外科,浙江省衢州324000

出　　处：《中国基层医药》2014年第4期513-515,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较腹腔镜下切割闭合器（Endo-GIA）脾蒂离断法与二级脾蒂血管离断法在门脉高压腹腔镜脾切除中的应用价值。方法回顾性分析34例门脉高压脾肿大行腹腔镜脾切除治疗患者的临床资料，根据手术方法不同分为：A组Endo．GIA处理脾蒂19例，B组二级脾血管离断15例。比较两组手术时间、术中出血量、术后住院时间、术后并发症、住院总费用。结果A、B组手术时间[（144±20）min比（127±8）min]差异无统计学意义（t=0．249，P〉0．05），B组术中出血、术后住院时间、住院总费用分别为（107±37）mL、（13．8±1．7）d、（3．36±0．36）万元，均少于A组的（229±113）mL、（15．4±2．7）d、（4．23±0．71）万元（t=7．774、2．572、2．930，均P〈0．05）。A组术后并发症均多于B组（均P〈0．05）。结论二级脾蒂血管离断法在门脉高压性肝硬化脾肿大腹腔镜脾切除术中有着胰腺损伤率低、出血少、住院费用少的优点，值得推广。Objective To compare the application value of Endo-GIA splenic pedicle dissection and second- ary splenic pedicle vascular dissection in laparoscopic splenectomy of portal hypertension. Methods The clinical data of 34 portal hypertension patients with splenomegaly who received laparoscopic splenectomy were retrospectively analyzed. According to the different surgical methods, the patients were divided into A group （Endo-GIA for splenic pedi- cle, 19 cases） and B group（ secondary transection for splenic vessels, 15 cases）. The operative time,blood loss,postoperative hospital stay, postoperative complications, the total cost of the two groups were compared. Results The operation time of A group and B group[ （ 144±20） min vs. （ 127 ± 8 ） mini had no significant difference（ t = 0. 249 ,P 〉 0.05 ）. The blood loss, postoperative hospital stay, hospital costs of B group were （ 107 ± 37 ） mL, （ 13.8 ± 1.7 ） d, （3.36 ±0.36）ten thousand yuan, respectively, which were less than those of A group[ （229 ±113 ）mL, （15.4 ± 2. 7 ） d, （4.23 ± 0.71 ） ten thousand yuan ] （ t = 7. 774,2. 572,2. 930, all P 〈 0.05 ）. The postoperative complications of A group were more than those of B group （ all P 〈 0.05）. Conclusion Secondary splenic pedicle vascular dissection in laparoscopic splenectomy of portal hypertension has lower incidence rate of pancreatic injury,less bleeding and hospitalization cost, and it is worthy of promotion.

关 键 词：脾切除术 腹腔镜 

分 类 号：R657.6[医药卫生—外科学]