腹腔镜技术在脾脏恶性肿瘤的诊疗经验  

Experience in The Treatment of Splenic Malignant Tumors with Laparoscopy

作　　者：孟令威[1] 蔡合 蔡云强[1] 李永彬[1] 彭兵[1] 

机构地区：[1]四川大学华西医院肝胆胰外科,四川成都610041

出　　处：《中国普外基础与临床杂志》2016年第4期429-433,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜技术在脾脏恶性肿瘤的诊疗经验。方法回顾性复习笔者所在医院2009年1月至2015年7月期间行外科手术治疗的51例脾脏恶性肿瘤患者的临床资料。根据手术方式不同分为开腹组(n=18)和腹腔镜组(n=33)2组,收集并比较2组患者的术前、术中及术后的临床资料,比较开腹组及腹腔镜组围手术期各指标差异,包括患者的一般情况,术中情况(手术时间、术中出血量、围手术期输血情况)以及术后情况(住院时间,进食时间,以及胰瘘、再出血、腹腔及肺部感染发生率,术后是否镇痛等)。结果腹腔镜组与开腹组相比,腹腔镜组较开腹组手术时间明显缩短〔(103.64±16.92)min比(144.44±31.10)min,P=0.000〕,腹腔镜组术中出血量〔M(Q_(25),Q_(75))为60(50,100)〕较开腹组〔M(Q_(25),Q_(75))为150(115,210)〕明显减少(P=0.000),且腹腔镜组术后住院时间较开腹组明显缩短〔(13.61±9.91)d比(9.03±3.09)d,P=0.017〕,腹腔镜组出现发热及肺部感染人数较开腹组明显减少(P=0.010及P=0.003)。结论腹腔镜技术在脾脏恶性肿瘤切除手术中是可行的,腹腔镜技术的应用使手术时间缩短,具有术中出血少、住院时间缩短、术后并发症发生率低等优点,值得进一步推广应用。Objective To investigate the experience in the treatment of splnic malignant tumors with laparoscopy.Methods The clinical data of 51 patients with splnic malignant tumor who underwent splenectomy between January2009 and July 2015 were retrospectively reviewed. Patients were divided into two groups based on the surgical method：Open splenectomy（OS group, n=18） and laparoscopic splenectomy（LS group, n=33）. The preoperative, intraoperative and postoperative data of the patients were collected and analysed, the differences of each index during perioperative period（general information）, intraoperative data（operative time, estimated blood loss, the size of spleen, intraoperaive transfusion） and postoprative situation（hospital stays, the first oral intake, postoperative pancreatic fistula, rehaemorrhagia,abdominal infection or pulmonary infection and the like） were compared. Results LS group compared with OS group, the operative time of LS group was significantly shorter than that of OS group 〔（103.64±16.92） min vs.（144.44±31.10） min,P=0.000〕, the amount of bleeding of LS group 〔M（Q_（25）,Q_（75））： 60（50,100）〕 was significantly less than the OS group〔M（Q_（25）,Q_（75））： 150（115,210）〕, P=0.000. The hospitalization time of LS group was significantly shorter than the OS group 〔（13.61±9.91） d vs.（9.03±3.09） d, P=0.017〕, and the LS group has a lower indication of the postoprative complications of fever and pulmonary infection（P=0.010 and P=0.003）. Conclusions Laparoscopic splenectomy is feasible in the treatment of splenic malignant tumors, the employment of laparoscopy can shorten the operative time, has the advantages of less bleeding, the shorten hospital stays, lower indication of postoprative complications, and being worthy of further popularization and application.

关 键 词：腹腔镜 脾脏恶性肿瘤 脾切除术 

分 类 号：R733.2[医药卫生—肿瘤]