腹腔镜二级脾蒂离断法脾切除术在肥胖病人中的应用  

Application of laparoscopic splenectomy in the obese patients by the amputation of secondary splenic pedicel

作　　者：殷强 晏华军 王思远 沈雄山[1] Yin Qiang;Yan Huajun;Wang Siyuan;Shen Xiongshan(Department of Hepatobiliary Surgery,Xiaogan Hospital of Wuhan University of Science and Technology,Hubei Xiaogan 432000,China)

机构地区：[1]武汉科技大学附属孝感医院肝胆外科,湖北孝感432000

出　　处：《腹部外科》2019年第2期103-107,共5页Journal of Abdominal Surgery

摘　　要：目的研究腹腔镜二级脾蒂离断法脾切除术在肥胖病人中的应用。方法回顾性分析武汉科技大学附属孝感医院肝胆外科2015年4月至2018年10月收治的37例肝硬化门静脉高压症病人应用二级脾蒂离断法行腹腔镜脾切除术的临床资料。按照体质量指数(BMI)将病人分为两组:肥胖组(BMI≥28 kg/m^2)和非肥胖组(BMI<28 kg/m^2)。比较两组病人手术时间、术中出血量、中转开腹手术发生率、住院时间以及术后并发症发生情况。结果肥胖病人手术时间、术中出血量高于非肥胖组[分别为(176.3±28.7) min比(147.9±23.5) min、(213.2±23.4) ml比(192.6±19.7) ml,P<0.05],而两组中转开腹手术发生率、住院时间、术后并发症发生率差异均无统计学意义[16.7%比4.0%、(9.7±1.6) d比(9.1±1.9) d、33.3%比8.0%,均P>0.05]。结论腹腔镜二级脾蒂离断法脾切除术在肥胖病人中应用是安全、可行的,但可能会增加手术风险,术中应谨慎操作。Objective To study the application of laparoscopic splenectomy in the obese patients by the amputation of secondary splenic pedicel. Methods The clinical data of 37 patients with cirrhosis and portal hypertension who underwent laparoscopic splenectomy with the amputation of secondary structures of the spleen pedicel from April 2015 to October 2018 were retrospectively analyzed.Patients were divided into two groups according to body mass index (BMI): obese (BMI≥28 kg/m 2) and non-obese (BMI<28 kg/m 2).The operation time,blood loss,conversion rates,length of stay and postoperative complications were analyzed and compared. Results The obese group was worse than non-obese group in the operation time and blood loss (176.3±28.7 min vs.147.9±23.5 min, 213.2 ±23.4 ml vs.192.6±19.7 ml,P<0.05). There was no significant differences between the two groups in the conversion rates, the length of stay and postoperative complications (16.7%vs. 4.0%,9.7±1.6 d vs. 9.1±1.9 d、33.3%vs. 8.0%,P>0.05). Conclusion The application of laparoscopic splenectomy by the amputation of secondary splenic pedicel was safe and feasible in the obese patients, and this kind of surgery should be performed with caution as it may increase surgical risk.

关 键 词：腹腔镜脾切除术 二级脾蒂离断法 肥胖 门静脉高压症 

分 类 号：R615[医药卫生—外科学]