脾动脉优先入路的腹腔镜脾切除术安全性分析  

Safety analysis of laparoscopic splenectomy with preferential splenic artery approach

作　　者：李志飞 夏医君 国成龙 邬一峰 王石 LI Zhi-fei;XIA Yi-jun;GUO Cheng-long(Department of Hepatobiliary Pancreaticosplenic Surgery,Inner Mongolia Regional People's Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古治区人民医院肝胆胰脾外科,010017 [2]内蒙古医科大学,010050

出　　处：《中国实用医药》2023年第13期40-43,共4页China Practical Medicine

摘　　要：目的 探讨脾动脉优先入路的腹腔镜脾切除术(LS)的安全性及可行性。方法 68例需行脾切除术患者,根据术中是否先行结扎脾动脉分为观察组(38例)和对照组(30例)。观察组患者实施优先结扎脾动脉的腹腔镜脾切除术,对照组患者实施非优先结扎脾动脉的腹腔镜脾切除术。比较两组患者手术相关指标、术后并发症发生情况。结果 观察组患者全部完成优先结扎脾动脉的腹腔镜脾切除术,无中转开腹,无围手术期死亡;对照组患者28例成功完成非优先结扎脾动脉的腹腔镜脾切除术,2例中转开腹,无围手术期死亡。观察组患者手术时间(124.50±23.46)min、术后住院时间(7.53±0.96)d、术后拔除引流管时间(5.35±0.81)d、术后胃管留置时间(2.35±0.48)d均短于对照组的(158.71±38.13)min、(8.35±1.04)d、(6.41±1.16)d、(2.64±0.54)d,术中出血量(122.06±50.87)ml少于对照组的(188.06±106.61)ml,差异具有统计学意义(P<0.05)。两组患者术后并发症均为Ⅰ级,未发生Ⅱ级及以上并发症。观察组患者术后并发症发生率为15.79%,低于对照组的43.33%,差异具有统计学意义(P<0.05)。结论 脾动脉优先入路的腹腔镜脾切除术是安全、可行的,是腹腔镜脾切除术手术方式的优化。Objective To discuss the safety and feasibility of laparoscopic splenectomy(LS)with preferential splenic artery approach.Methods A total of 68 patients requiring splenectomy were divided into an observation group(38 patients)and a control group(30 patients)according to whether the splenic artery was ligated first intraoperatively.Patients in the observation group underwent laparoscopic splenectomy with preferential ligation of the splenic artery,and patients in the control group underwent laparoscopic splenectomy without preferential ligation of the splenic artery.The surgery-related indexes and postoperative complications in the two groups were compared.Results All patients in the observation group completed laparoscopic splenectomy with preferential ligation of splenic artery,no conversion to laparotomy,no perioperative death.In the control group,28 patients underwent laparoscopic splenectomy without preferential ligation of the splenic artery,and 2 patients underwent laparotomy without perioperative death.The observation group had operative time of(124.50±23.46)min,postoperative hospitalization time of(7.53±0.96)d,postoperative drainage tube removal time of(5.35±0.81)d and postoperative gastric tube retention time of(2.35±0.48)d,which were all shorter than those of(158.71±38.13)min,(8.35±1.04)d,(6.41±1.16)d and(2.64±0.54)d in the control group;the intraoperative blood loss of(122.06±50.87)ml in the observation group was less than that of(188.06±106.61)ml in the control group;the differences were statistically significant(P<0.05).Postoperative complications of both groups were in gradeⅠ,and no complications of gradeⅡor above occurred.The incidence of postoperative complications was 15.79%in the observation group,which was lower than that of 43.33%in the control group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic splenectomy with preferential splenic artery approach is safe,feasible and an optimization of laparoscopic splenectomy.

关 键 词：脾动脉优先入路 腹腔镜 脾切除术 脾脏疾病 

分 类 号：R657.6[医药卫生—外科学]