腹腔镜和开腹脾切除术的临床疗效比较:附视频  

Comparative study of clinical efficacy of laparoscopic splenectomy and open splenectomy: video attached

作　　者：薛红娣[1] 刘双海[1] 陈胜[1] 胡俊[1] 周一夫[1] 

机构地区：[1]东南大学医学院附属江阴医院肝胆外科,江阴214400

出　　处：《中华普通外科学文献（电子版）》2016年第2期125-128,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的通过对腹腔镜脾切除术(LS)和开腹脾切除术(OS)临床病例的对照分析,总结LS的临床应用,探讨其安全性及优缺点。方法选择2013年6月至2015年6月收治的20例OS患者为对照组,同期20例LS患者为研究组。比较两组患者的临床疗效,包括手术时间、术中出血量、术后住院时间、并发症和术后6、12、24 h视觉模拟评分、肝功能变化(谷草转氨酶AST、血清白蛋白ALB、谷丙转氨酶ALT)和免疫功能变化(CD_4^+、CD_8^+、CD_4^+/CD_8^+)。结果与对照组相比,研究组手术时间明显延长(P<0.05),术中出血量、术后住院时间显著减少(P<0.05),两组均无胰漏、出血、膈下积液等并发症。研究组术后6、12、24 h时VAS评分以及术后第3天AST、ALT水平明显低于对照组(P<0.05),CD_4^+和CD_4^+/CD_8^+水平明显高于对照组(P<0.05)。结论腹腔镜脾切除术具有微创优势,术中出血量少,术后疼痛轻,改善肝功能和免疫功能,临床效果优于开腹脾切除术。Objective To compare the clinical efficacy of laparoscopic splenectomy（LS） andopen splenectomy（OS）, and to study the safety, advantages and disadvantages of LS. Methods FromJune 2013 to June 2015, twenty cases undergoing OS were selected as the control group, other 20 patientswith LS at the same period were selected as the study group. The clinical effect including operative time,blood loss, postoperative hospital stay, complications and visual analog scale score-VAS at postoperative6-, 12-, 24-h, liver function（aspartate aminotransferase-AST, serum albumin-ALB, alanine aminotrans-ferase-ALT） and immune function（CD4＋, CD8＋ and CD4＋/CD8＋） were compared between two groups.Results Compared to the control group, operation time in the study group was significantly longer（P〈0.05）, and blood loss, postoperative hospital stay was significantly less（P〈0.05）. There was no pancre-atic leakage, bleeding, subphrenic effusion in the two groups. VAS scores at postoperative 6-, 12-, 24-hand AST, ALT at postoperative 3 d in the study group were significantly lower than those in the controlgroup（P〈0.05）. CD4＋and CD4＋/CD8＋at postoperative 3 d in the study group were significantly higherthan those in the control group（P〈0.05）. Conclusion Laparoscopic splenectomy is safe and effectivetherapy with minimal invasion, less blood loss, quick recovery, which can improve liver function and im-mune function of patients.

关 键 词：腹腔镜 脾切除术 开腹 肝功能 免疫 

分 类 号：R657.6[医药卫生—外科学]