选择性脾动脉栓塞术对急诊外伤性脾破裂救治的效果探讨  

Effect of selective splenic artery embolization on emergency treatment of traumatic splenic rupture

作　　者：牟奇海 彭科 邱远 刘高 刘会勇 MU Qi-hai;PENG Ke;QIU Yuan;LIU Gao;LIU Hui-yong(Emergency Department,Kaizhou People′s Hospital,Chongqing 405400,China;Department of General Surgery,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]开州区人民医院急救科,重庆405400 [2]陆军军医大学第二附属医院普外科,重庆400037

出　　处：《局解手术学杂志》2020年第5期410-413,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市科卫联合医学科研项目(2019QNXM019)。

摘　　要：目的探讨在急诊外伤性脾破裂的救治中实施选择性脾动脉栓塞术(PSAE)的效果。方法选择2015年3月至2019年8月收治的86例外伤性脾破裂患者,根据患者的意愿分为修补组(n=43)和栓塞组(n=43),修补组实施脾修补术,栓塞组实施PSAE。比较2组患者手术时间、术中出血量、下床时间、住院时间、T淋巴细胞水平及并发症发生情况。结果栓塞组患者手术时间、下床时间及住院时间均短于修补组(P=0.002、0.012、0.007),术中出血量少于修补组(P=0.000);治疗14 d后栓塞组CD3+、CD4+、CD4/CD8+水平高于修补组(P=0.023、0.018、0.011),CD8+水平低于修补组(P=0.015)。栓塞组共有3例患者(6.98%)发生并发症,而修补组有10例(23.26%)发生并发症,2组比较差异有统计学意义(P<0.05)。结论PSAE应用于急诊外伤性脾破裂效果良好,可缩短手术至康复所需时间,同时起到改善免疫功能的作用。Objective To explore the effect of selective splenic artery embolization(PSAE)in emergency treatment of traumatic splenic rupture.Methods From March 2015 to August 2019,86 patients with traumatic splenic rupture were selected and divided into repair group(n=43)and embolization group(n=43)according to patients′will.Patients in repair group were treated with splenic repair,while patients in embolism group were treated with PSAE.The operation time,intraoperative blood loss,time out of bed,hospital stay,level of T lymphocyte and complications were compared between the two groups.Results The operation time,time of getting out of bed and length of hospital stay in the embolization group were shorter than those in the repair group(P=0.002,0.012,0.007),the intraoperative blood loss in the embolization group was less than that in the repair group(P=0.000).The levels of CD3+,CD4+,CD4/CD8+in the embolization group were higher than those in the repair group(P=0.023,0.018,0.011)14 days after treatment,and the level of CD8+was lower than that in the repair group(P=0.015).There were 3 cases(6.98%)with complications in the embolization group and 10 cases(23.26%)in the repair group,the difference between the two groups was statistically significant(P<0.05).Conclusion PSAE has a good effect on emergency traumatic splenic rupture.It can shorten the time from operation to rehabilitation and improve the immune function at the same time.

关 键 词：选择性脾动脉栓塞术 外伤性脾破裂 免疫功能 脾修补术 并发症 急诊 

分 类 号：R657.62[医药卫生—外科学] R605.97[医药卫生—临床医学]