肥胖及脾长径对腹腔镜脾切除联合贲门周围血管离断术安全性的影响  

Impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization

作　　者：徐教邦[1] 李国强[1] 王希超[1] 李鹏[1] 袁庆忠[1] 

机构地区：[1]胜利油田中心医院肝胆外科,山东东营257034

出　　处：《中华肝胆外科杂志》2017年第3期181-185,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：吴阶平医学基金会临床科研专项（320.6750.13237）

摘　　要：目的 探讨肥胖及脾长径对腹腔镜脾切除联合贲周血管离断术安全性的影响.方法 回顾性分析2009年9月至2016年4月我院收治的121例门静脉高压症行腹腔镜脾切除联合贲周血管离断术患者的临床资料.根据BMI指数将患者分为肥胖组（BMI≥25 kg/m^2）和非肥胖组（BMI＜ 25 kg/m2）,并根据脾长径将患者分为脾AC线＞20 cm组及脾AC线≤20 cm组.结果 （1）肥胖患者手术时间、中转手术率、术后并发症出现率均高于非肥胖组[分别为（184.0 ±49.0） min比（142.0 ±39.0） min、26.1％比8.0％、26.1％比6.7％,P＜0.05],而两组术中出血及术后拔管时间差异无统计学意义（P＞0.05）.脾AC线长径≥20 cm患者,肥胖组术中中转手术率及术后并发症发生率均高于非肥胖组,差异有统计学意义（分别为42.9％比11.7％,33.3％比8.8％,均P＜0.05）;脾AC线＜20 cm患者肥胖与非肥胖组多项指标差异均无统计学意义,均P＞0.05.（2）肥胖患者中,脾AC线长径≥20 cm亚组手术时间及中转手术率高于脾AC线长径＜20 cm亚组[分别为（224.0±42.0）min比（152.0±44.0） min,42.9％比12.0％,均P＜0.05],两组患者术中出血、术后引流管拔出时间及术后并发症发生率差异均无统计学意义（P＞0.05）;而脾长径并未影响非肥胖患者手术及术后并发症发生率.结论 肥胖延长了腹腔镜脾切除联合贲周血管离断的手术时间,增加了中转手术率及术后并发症发生率,而脾长径对肥胖患者中转手术率及并发症的发生作用明显.Objective To evaluate the impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization.Methods We retrospectively analyzed 121 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in our hospital.Using BMI,these patients were classified as the obesity and the non-obesity groups.Using length of the spleen,the patients were divided into two subgroups：spleen AC diameter 〉 20 cm and spleen AC diameter ≤20 cm.Results （1） For the Obesity group,the operation time,the rate of conversion to open operation and the complication rate after operation were higher than the non-obesity group [（184.0 ± 49.0） min vs （142.0 ±39.0） min,26.1% vs 8.0%,26.1% vs 6.7%,respectively,P〈0.05].However,the differences were not significant for mean blood loss,intraperitoneal drainage and complication rate after operation.For patients with massive splenomegaly,the obesity group had higher rates of conversion into open operation and complication （42.9% vs 11.7%,33.3% vs 8.8%,respectively,P 〈0.05）.For patients with non-massive splenomegaly,the differences were not significant between the obesity and non-obesity groups （P 〉 0.05）.（2） For obesity patients,the spleen AC diameter 〉 20 cm group had a longer operation time and a higher rate of conversion to open operation [（224.0 ± 42.0） min vs （152.0 ± 44.0） min,42.9% vs 12.0%,respectively,P 〈 0.05].The length of spleen had no effect on the operation and its complication （P 〉 0.05）.Conclusions Obesity extended the operation time and increased the rates of conversion to open operation and complication after operation.The spleen length had a major impact on the rates of conversion to open operation and complication after operation for the groups of obesity patients.

关 键 词：腹腔镜脾切除 脾切除联合贲周血管离断术 肥胖 脾长径 

分 类 号：R657.3[医药卫生—外科学]