腹腔镜脾切除术在治疗巨脾中的应用  

Application of laparoscopic splenectomy in the treatment of massive splenomegaly

作　　者：陈亚峰 李江斌 王栋 罗年安 臧莉 阴继凯 鲁建国 董瑞 Chen Yafeng;Li Jiangbin;Wang Dong;Luo Nianan;Zang Li;Yin Jikai;Lu Jianguo;Dong Rui(Department of General Surgery,the Second Affiliated Hospital,Air Force Military Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学第二附属医院普外科,西安710038

出　　处：《中华腔镜外科杂志（电子版）》2021年第3期152-157,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金青年项目(81700533);陕西省重点研发计划项目(2020SF-067)。

摘　　要：目的探讨腹腔镜脾切除术(laparoscopic spelenectomy,LS)在治疗巨脾患者中的安全性、可行性及效果。方法回顾性分析2012年1月至2019年12月行LS的362例患者资料,根据脾脏长径分为巨脾组(170例)和非巨脾组(192例)。比较两组手术情况、术后恢复情况、血常规、凝血功能、并发症、随访情况等。结果巨脾组手术时间较非巨脾组延长,差异有统计学意义(P<0.05);术中出血量、术后腹腔引流管拔除时间、术后恢复进食时间、术后住院时间比较,差异无统计学意义(P>0.05);术后1、3、5 d,两组WBC、HGB、PT比较,差异无统计学意义(P>0.05);术后1 d,两组PLT比较,差异无统计学意义(P>0.05);而术后3、5 d,巨脾组PLT明显高于非巨脾组,差异有统计学意义(P<0.05)。两组术后并发症中的腹腔出血、腹腔感染、肺部感染、胰漏、门静脉系统血栓(portal venous system thrombosis,PVST)、切口感染比较,差异无统计学意义(P>0.05)。术后1、12个月,两组WBC、PLT、HGB、PT比较,差异无统计学意义(P>0.05)。术后PVST发生率为12.4%,PVST形成与患者体质量指数、D-二聚体、PLT、门静脉直径、脾静脉流速、术前PVST显著相关(P<0.05)。结论巨脾行LS是安全、可行、有效的,术后早期抗凝治疗可以降低PVST形成。Objective To investigate the safety,feasibility and effect of laparoscopic splenectomy(LS)in the treatment of patients with massive splenomegaly.Methods The clinical data of 362 patients who underwent LS from Jan.2012 to Dec.2019 were retrospectively analyzed.According to the length of spleen,all the patients were divided into massive splenomegaly group and non-massive splenomegaly group.The operative outcomes,postopertive recovery,routine blood,blood coagulation functions,complications and follow-up situations in the two groups of patients were compared.Results Operation time in the massive splenomegaly was longer than that in the non-massive splenomegaly,with statistically significant differences between groups(<0.05).There were no significant differences in intraoperative blood loss,time of postoperative abdominal drainage-tube removal,time of gastrointestinal function recovery and duration of hospital stay(>0.05).There were no significant differences in WBC,HGB and PT on postoperative day 1,postoperative day 3 and postoperative day 5(>0.05).There were no significant differences in PLT on postoperative day 1(>0.05).PLT in the massive splenomegaly group were significantly higher than that in the non-massive splenomegaly group on postoperative day 3 and day 5(<0.05).The main complications included intra-abdominal bleeding,intra-abdominal infection,pulmonary infection,pancreatic fistula,portal vein system thrombosis(portal venous system thrombosis,PVST)and incision infection between the two groups showed no significant difference(>0.05).There were no significant differences in WBC,PLT,HGB and PT on postoperative 1-month and 12-month(>0.05).The incidence of PVST was 12.4%,and PVST was significantly correlated with BMI,D-dimer,PLT,diameter of portal vein,velocity of splenic vein,and preoperative PVST(<0.05).Conclusions LS for massive splenomegaly is safe,feasible and effective,and early anticoagulant therapy postoperative can reduce PVST.

关 键 词：腹腔镜 脾切除术 巨脾 脾功能亢进 

分 类 号：R73[医药卫生—肿瘤]