困难性脾切除术269例  

269 cases of difficult splenectomy

作　　者：关蛟 周尊强[1] 陈世赓 孙建华 张正筠[1] 周光文[1] Guan Jiao;Zhou Zunqiang;Chen Shigeng;Sun Jianhua;Zhang Zhengyun;Zhou Guangwen(Department of Surgery,Shanghai Jiaotong University Affiliated Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院外科,上海200233

出　　处：《腹部外科》2019年第2期84-88,共5页Journal of Abdominal Surgery

摘　　要：目的探讨困难性脾切除术的外科疗效。方法采用回顾性分析2005年1月至2018年12月上海交通大学附属第六人民医院收治的269例困难性脾切除病人的临床资料。结果 229例病人采用二级脾蒂离断术,40例病人采用非二级脾蒂离断术,术中出血量为(226±107) ml;切脾时间为(78±32) min。围手术期无病人死亡,无胰漏和胃结肠损伤。35例出现术后并发症:腹腔内出血13例;肺部并发症20例,其中14例左胸腔积液病人有3例合并左膈下脓肿。脾静脉栓塞性静脉炎18例;大量腹水24例。经再次手术或非手术治疗后痊愈。血吸虫肝硬化巨脾切除后脾静脉栓塞和门静脉主干栓塞形成(包括完全和不完全)高达32.5%(13/40),而乙型病毒性肝炎肝硬化后脾切除后栓塞形成率为8.9%(14/161),两者比较差异有统计学意义(χ~2=9.4,P<0.05)。结论认真仔细的术前评估、精细轻柔的手术操作、脾蒂的正确处理和创面的腹膜化,是减低困难性脾切除手术风险的关键环节。Objective To investigate the surgical effect of difficult splenectomy.. Methods The clinical data of 269 patients with difficult splenectomy from January 2005 to December 2018 in Shanghai Jiaotong University Affiliated Sixth People's Hospital were analyzed retrospectively. Results 229 patients were treated with secondary splenic pedicle dissection and 40 patients with non-secondary splenic pedicle dissection.The intraoperative blood loss was (226±107) ml and the splenectomy time was (78±32) min.No perioperative death,pancreatic leakage and gastrocolic injury occurred.Postoperative complications occurred in 35 cases:13 cases of intra-abdominal hemorrhage,20 cases of pulmonary complications,and 3 cases of 14 patients with left pleural effusion combined with left subphrenic abscess.There were 18 cases of splenic vein embolism phlebitis and 24 cases of massive ascites.Patients recovered after reoperation or non-surgical treatment.Splenic vein thrombosis and main portal vein thrombosis (both complete and incomplete) were as high as 32.5%(13/40) after splenectomy in patients with schistosomal cirrhosis,while the embolization rate after splenectomy in patients with viral hepatitis B cirrhosis was 8.9%(14/161).A significant difference was observed between the two groups(χ^2=9.4,P<0.05). Conclusion Careful preoperative evaluation,sophiscated and gentle operation,proper treatment of splenic pedicle and peritoneum of wound surface are the key steps to reduce the risk of difficult splenectomy.

关 键 词：困难性脾切除 巨脾 门静脉高压症 

分 类 号：R657.34[医药卫生—外科学]