腹腔镜技术治疗外伤性脾破裂的临床体会  

Application of laparoscopic technique in the treatment of traumatic splenic rupture

作　　者：谭海东[1] 司爽[1] 黄笳 徐力[1] 刘笑雷[1] 孙永亮[1] 刘立国[1] 周文颖[1] 杨志英[1] TAN Hai-dong;SI Shuang;HUANG Jia(Department of General Surgery,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院,北京100029

出　　处：《腹腔镜外科杂志》2018年第9期697-699,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜技术治疗外伤性脾破裂的应用价值及临床效果。方法:回顾分析2009年1月至2017年9月采用腹腔镜手术治疗的15例外伤性脾破裂患者的临床资料。其中男13例,女2例,17～66岁。患者均有左上腹外伤史,以腹胀、腹痛等为主要临床表现,经超声、腹部CT或诊断性腹腔穿刺确诊为外伤性脾破裂。结果:8例行腹腔镜脾切除术,7例行腹腔镜保脾止血术,无一例中转开腹。脾切除组较保脾组手术时间短,术后1周血小板水平及术后1个月血小板增高比例高(P<0.05),两组术中出血量、术后住院时间差异无统计学意义(P>0.05)。术后无一例发生严重并发症。结论:腹腔镜技术治疗外伤性脾破裂安全、有效,应根据患者病情,结合术者经验,选择适合的腹腔镜治疗方式。To explore the value and clinical efficacy of laparoscopic technique in the treatment of traumatic splenic rupture.Methods:A retrospective analysis was performed on the clinical data of 15 patients who underwent laparoscopic surgery for traumatic splenic rupture from Jan.2009 to Sep.2017.This study included 13 males and 2 females.The age of patients ranged from 17 to 66 years old.All the patients had a history of trauma in the left upper abdomen.The main clinical symptoms were distension or pain of the abdomen.And the diagnosis of splenic rupture was confirmed by ultrasound,CT or diagnostic puncture.Results:Eight patients underwent laparoscopic total splenectomy while seven got laparoscopic spleen preserving hemostasis surgery.No patient was converted to laparotomy during operation.The laparoscopic total splenectomy group had shorter operation time but higher PLT level and ratio postoperatively than the laparoscopic spleen preserving hemostasis group(P<0.05).There was no difference in blood loss or postoperative hospital stay between the two groups(P>0.05).No postoperative severe complications were found among all the patients.Conclusions:Laparoscopic surgery is safe and effective in the treatment of traumatic splenic rupture.And the choice of the laparoscopic total splenectomy or laparoscopic spleen preserving hemostasis surgery should be based on the severity of the disease and the experience of surgeon.

关 键 词：脾破裂 脾切除术 保脾手术 腹腔镜检查 

分 类 号：R657.62[医药卫生—外科学]