腹腔镜脾脏切除术16例临床分析  

A clinical analysis of 16 cases of laparoscopic splenectomy

作　　者：龚海军 余春华 鲁钢 贺青 张银才 GONG Haijun;YU Chunhua;LU Gang;HE Qing;ZHANG Yincai(Department of General Surgery,the People's Hospital of Lincang City in Yunnan Province,Lincang,677000,China)

机构地区：[1]云南省临沧市人民医院普通外科,云南临沧677000

出　　处：《中国现代医生》2020年第24期46-48,共3页China Modern Doctor

摘　　要：目的以肝硬化致脾功能亢进患者为研究对象,探讨患者应用腹腔镜脾脏切除术的治疗效果。方法将2018年1月~2019年12月接受手术治疗肝硬化致脾功能亢进症患者32例随机分成两组,对照组16例患者应用开腹脾脏切除术治疗,观察组16例患者应用腹腔镜脾脏切除术治疗,观察对比两组手术相关指标、手术前后肝功能指标及术后并发症情况。结果观察组术中失血量(287.46±36.01)mL、手术时间(105.39±15.27)min、拔管时间(4.71±1.50)d、术后住院时间(7.66±2.48)d,对照组各项指标分别为(335.23±35.28)mL、(83.51±14.34)min、(6.23±1.49)d、(10.23±2.60)d,观察组术中失血量少于对照组,手术时间长于对照组,拔管时间以及术后住院时间均短于对照组(P<0.05)。术后观察组DBIL为(7.23±1.30)μmol/L、AST为(37.28±4.39)μmol/L、ALT为(40.13±3.28)μmol/L,对照组各项指标分别为(9.64±1.35)μmol/L、(51.19±4.47)μmol/L、(47.36±3.31)μmol/L,差异有统计学意义(P<0.05)。观察组TBIL为(26.02±3.17)μmol/L、对照组为(25.68±3.19)μmol/L,两组TBIL水平无统计学意义(P>0.05)。观察组无肺部感染者,胸腔积液率为6.25%、切口感染率为6.25%、腹腔积液率为12.50%。观察组肺部感染、胸腔积液及切口感染发生率均较对照组低(P<0.05),两组腹腔积液发生率差异无统计学意义(P>0.05)。结论腹腔镜脾脏切除术在肝硬化致脾功能亢进治疗中的应用价值较高,能够取得确切疗效且治疗安全性较高,可显著改善患者肝功能。Objective To explore the therapeutic effect of laparoscopic splenectomy(LS)on the patients with hypersplenism caused by hepatocirrhosis.Methods 32 patients with hypersplenism caused by hepatocirrhosis who received surgical treatment from January 2018 to December 2019 were randomly divided into two groups.The 16 patients of the control group were treated with open splenectomy,while the 16 patients of the observation group were treated with LS.The operation-related indexes,liver function indexes before and after operation and postoperative complications of the two groups were observed and compared.Results In the observation group,the intraoperative blood loss was(287.46±36.01)mL,the operation time was(105.39±15.27)min.,the extubation time was(4.71±1.50)d,the postoperative hospitalization time was(7.66±2.48)d,while in the control group,the corresponding indexes were(335.23±35.28)mL,(83.51±14.34)min,(6.23±1.49)d,and(10.23±2.60)d respectively.The blood loss in the observation group was less than that in the control group,the operation time was longer than that in the control group,and the extubation time and the postoperative hospitalization time were both shorter than those in the control group(P<0.05).The DBIL of the observation group after operation was(7.23±1.30)μmol/L,the AST was(37.28±4.39)μmol/L,and the ALT was(40.13±3.28)μmol/L,while these indexes of the control group were(9.64±1.35)μmol/L,(51.19±4.47)μmol/L,and(47.36±3.31)μmol/L respectively,the difference was statistically significant(P<0.05).The TBIL of the observation group was(26.02±3.17)μmol/L,while that of the control group was(25.68±3.19)μmol/L,with no statistically significant difference in TBIL level between the two groups(P>0.05).There was no pulmonary infection in the patients of the observation group,the incidence of pleural effusion was 6.25%,the incidence of incision infection was 6.25%,and the incidence of peritoneal effusion was 12.50%.The incidence of pulmonary infection,pleural effusion and incision infection in the o

关 键 词：腹腔镜脾脏切除术 肝硬化 脾功能亢进 肝功能 手术指标 术后并发症 

分 类 号：R657.6[医药卫生—外科学]