腹腔镜与开腹脾切除术治疗血吸虫性肝硬化致脾功能亢进的比较  

Comparison of laparoscopic splenectomy and open splenectomy for hypersplenism caused by schistosomal cirrhosis

作　　者：赵红欣[1] 周鸿鲲[2] 张浩[2] 徐鹿平[2] 谢琦[2] 

机构地区：[1]嘉善县第二人民医院外科,浙江嘉善314102 [2]嘉兴学院医学院附属第一医院普外科

出　　处：《全科医学临床与教育》2014年第3期253-255,共3页Clinical Education of General Practice

摘　　要：目的探讨腹腔镜脾切除术治疗血吸虫性肝硬化引起的脾功能亢进的临床应用价值。方法对50例血吸虫性肝硬化脾亢患者行脾切除术,其中腹腔镜组(A组)31例行完全腹腔镜手术,开腹组(B组)19例行传统开腹手术。比较两组患者的手术时间、术中出血量、术后住院时间、术后1 d切口疼痛评分、术后3 d超敏C反应蛋白(hsCRP)及引流液淀粉酶(Amy)、术后7 d血小板计数(Plt)、白细胞计数(WBC)。结果 A组成功完成腹腔镜手术29例,中转开腹2例。A组手术时间较B组长,术后1 d切口疼痛评分、术后住院时间及术后3d hs-CRP、Amy指标A组均小于B组,差异具有统计学意义(t分别=3.21、5.10、7.16、3.00、1.74,P均<0.05),而两组术中出血量、术后7 d Plt、WBC差异均无统计学意义(t分别=1.47、1.02、0.67,P均>0.05)。结论采用腹腔镜脾切除术治疗血吸虫性肝硬化患者脾功能亢进是安全有效的。相对传统开腹手术而言,具有创伤小、恢复快,住院时间缩短,并发症少,术后疼痛轻等优点。Objective To investigate the value of laparoscopic splenectomy （LS） for hypersplenism caused by schistosomal cirrhosis. Methods Fifty hypersplenism patients divided to two groups, the patients of group LS （group A） accepted laparoscopic splenectomy,and the patients of group OS （group B） accepted open splenectomy （OS）. The terms such as operation duration, the estimated blood loss, postoperative hospital stay, the score of incision pain on 1 day after operation, hs-CRP and amylase level on 3 days after operation, Platelet count and WBC level on 7 days after operation were compared between the groups. Results Twenty nine cases of group A were completed under laparoscopy and 2 cases were converted to open surgery. Operation duration of group A was longer than that of the group B; the score of incision pain on 1 day after operation,hs-CRP and amylase level on 3 days after operation were better than those of the group B（t=3.21,5.10,7.16,3.00,1.74,P〈0.05）;there were no differences in the estimated blood loss, Platelet count and WBC level on 7 days after operation between two groups （t=1.47,1.02,0.67,P〉0.05）. Conclusion It is safe and effective of LS to treat hypersplenism caused by schistosomal cirrhosis. It has advantages of fewer traumas and postoperative pain, quicker recovery, shorter hospital stay and fewer complications.

关 键 词：腹腔镜 脾切除术 血吸虫性肝硬化 脾功能亢进 

分 类 号：R657.6[医药卫生—外科学]