脾切除联合脾片移植治疗Ⅲ～Ⅳ级脾破裂的疗效及对免疫功能和血栓形成风险的影响评估  

Analysis of clinical efficacy of splenectomy combined with splenic graft transplantation in treatment of Ⅲ ～ Ⅳ degree traumatic splenic rupture patients and its effect on immune function and risk of thrombosis

作　　者：韩涛[1] 张树顺[1] 郭亚民[1] 康旭萍[1] HAN Tao;ZHANG Shushun;GUO Yamin(Department of General Surgery, Qinghai People's Hospital ,Xining 810000,China)

机构地区：[1]青海省人民医院普外科,西宁810000

出　　处：《临床外科杂志》2018年第12期943-945,共3页Journal of Clinical Surgery

摘　　要：目的分析脾切除联合脾片移植治疗Ⅲ～Ⅳ级脾破裂的疗效及对免疫功能和血栓形成风险的影响。方法中重度外伤性脾破裂病人80例,根据手术治疗方式的不同,分为研究组及对照组,每组各40例,研究组采用脾切除联合自体脾片移植术治疗,对照组采用单纯脾切除手术治疗,比较两组病人的临床疗效。结果研究组手术时间为(91. 2±18. 5)分钟,对照组为(76. 6±15. 0)分钟,两组比较差异有统计学意义(P <0. 05),术中出血量、住院时间及术后首次进食时间比较差异无统计学意义(P> 0. 05);研究组病人的术后并发症率为20. 0%,对照组为12. 5%,两组比较差异无统计学意义(P> 0. 05);术后1个月研究组病人的免疫相关指与对照组比较明显改善,差异有统计学意义(P <0. 05);术后1、2周及1个月,研究组病人的血小板水平均低于对照组,差异有统计学意义(P <0. 05);术前两组病人Tuftsin因子水平比较差异无统计学意义(P> 0. 05),术后1个月研究组病人的Tuftsin因子水平显著升高,对照组则降低,研究组高于对照组(P <0. 05)。结论在安全性相近的情况下,脾切除联合自体脾片移植治疗Ⅲ～Ⅳ级脾破裂的疗效显著,可加快病人免疫功能的恢复,降低血栓形成的风险,但要严格把控适应证。Objective To investigate the clinical efficacy of splenectomy combined with splenic graft transplantation in treatment of Ⅲ - Ⅳ degree traumatic splenic rupture patients and its effect on immune function and risk of thrombosis. Methods 80 cases of Ⅲ - Ⅳ degree traumatic splenic rupture patients were regarded as research subjects,which were divided into study group with 40 cases and control group with 40 cases. Patients in control group were given routine splenectomy and patients in study group were given implantation of autologous spleen segments after splenectomy. The two groups were compared in terms of clinical efficacy. Results The study group[( 91. 2 ± 18. 5) min] takes more time than control group[( 76. 6 ± 15. 0) min,P < 0. 05]. The operative blood loss,postoperative hospital stay and postoperative complications were no significant difference( P > 0. 05). There was no significance in postoperative complications rate between study group( 20. 0%) and control group( 12. 5%,P > 0. 05). The immune function indexes were all better in study group than in the control group after the treatment( P < 0. 05).The platelets level at 1,2 weeks and 1 month after surgery in the study group was significantly lower than in the control group( P < 0. 05). The Tuftsin level in the study group was significantly higher than in the control group( P < 0. 05). Conclusion The implantation of autologous spleen segments after splenectomy in the treatment of Ⅲ - Ⅳ degree traumatic splenic rupture patients is significant,which can accelerate the recovery of the patient’s immune function and reduce the risk of thrombosis,but the indications should be strictly controlled.

关 键 词：脾切除 自体脾片移植 脾破裂 免疫功能 血栓 

分 类 号：R657.62[医药卫生—外科学]