脾动脉栓塞辅助腹腔镜脾切除术治疗门静脉高压脾功能亢进患者的术中观察  

Intraoperative obeservation of laparoscopic splenectomy assisted with splenic artery embolization in patients with hypersplenism secondary to portal hypertension and splenomegaly

作　　者：金鹏飞 吴华文 金德西 陈国富 Jin Pengfei;Wu Huawen;Jin Dexi;Chen Guofu(Department of Surgery Center,the First People's Hospital of Wenling,Zhejiang Wenling 317500,China)

机构地区：[1]浙江省温岭市第一人民医院外科中心,317500

出　　处：《中国医师进修杂志》2018年第12期1090-1093,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨术前脾动脉栓塞(SAE)辅助腹腔镜脾切除术(LS)治疗门静脉高压脾功能亢进患者的临床价值。方法回顾性分析2015年4月至2018年4月浙江省温岭市第一人民医院外科中心收治的38例门静脉高压脾功能亢进患者的相关临床资料,其中单纯行LS患者21例(单纯组),术前SAE辅助LS患者17例(联合组)。通过比较两组脾脏长径及肝功能Child-Pugh分级、手术时间、术中出血量、术中输血量及术中输血率、中转开腹手术等资料,对术前SAE辅助LS治疗门静脉高压继发性脾大伴脾功能亢进的疗效进行评价。结果联合组栓塞前脾脏体积(998±251)cm3,栓塞后(627±195)cm3,差异有统计学意义(P<0.05);单纯组有5例患者中转开腹手术,中转率为23.8%(5/21),联合组无中转开腹病例。与单纯组相比,联合组手术时间短[(143±27)min比(189±33)min]、术中出血量少[(155±49)ml比(302±76)ml)],差异均有统计学意义(P<0.05)。联合组术中2例输血,输血量(192±42)ml,单纯组术中7例输血,输血量(399±87)ml,联合组输血率和输血量均低于单纯组,差异有统计学意义(χ2=4.215,P=0.024;t=-3.091,P=0.029)。结论术前SAE辅助LS治疗门静脉高压继发性脾大伴脾功能亢进具有手术时间短、中转开腹率低、术中出血量少、术中输血量少及术中输血率低等优势。Objective To discuss introperative value of laparoscopic splenectomy(LS)treatment assisted with preoperative splenic artery embolization(SAE)in the patients with the hypersplenism secondary to portal hypertension and splenomegaly.Methods The clinical data of 38 patients with the hypersplenism secondary to portal hypertension and splenomegaly admitted to the First People′s Hospital of Wenling from April 2015 to April 2018 were analyzed.Among them,21 patients underwent LS alone(alone group)and 17 patients underwent LS assisted with preoperative SAE(combined group).Including length of the spleen and liver function Child-Pugh grade,operative time,blood transfusion rate,intraoperative blood loss,intraoperative blood transfusion volume and conversion rate were compared between two groups.Then the clinical value of LS treatment assisted with preoperative splenic artery embolization was discussed.Results The splenic volume of combined group was significantly reduced after SAE:(627±195)cm3 vs.(998±251)cm3,P<0.05.The conversion rate was 23.8%(5/21)in alone group,while no patient required open surgery in the combined group.Compared with that in alone group,operative time of the combined group was shorter [(143±27)min vs.(189±33)min],the blood loss volume was less [(155±49)ml vs.(302±76)ml)],and the differences were statistically significant(P<0.05).The blood transfusion rates of combined group was lower [2/17 vs.33.3%(7/21)],and intraoperative blood transfusion volume was less [(192±42)ml vs.(399±87)ml].The differences were statistically significant(P<0.05).Conclusions LS treatment assisted with preoperative SAE has some advantages,such as shorter operative time,lower surgical laparotomy rate,less intraoperative blood transfusion,less bleeding and shorter length of stay.

关 键 词：脾切除术 腹腔镜 脾动脉栓塞 脾功能亢进症 比较研究 

分 类 号：R657.34[医药卫生—外科学]