腹腔镜脾切除术在外伤性脾破裂中的应用价值  

The Application Value of Laparoscopic Splenectomy in Traumatic Splenectomy

作　　者：李国松[1] 李大华 宋国杰 杨晨 戈佳云 邵国辉[3] LI Guosong;LI Dahua;SONG Guojie;YANG Chen;GE Jiayun;SHAO Guohui(Dept.of General Surgery,The 2nd People’s Hospital of Baoshan,Baoshan Yunnan 678000;Dept.of Surgery,The 3rd Affiliated Hospital of Yunnan University of Traditional Chinese Medicine,Kunming Yunnan 650500;Dept.of Hepatobiliary and Pancreatic Surgery,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]云南省保山市第二人民医院普外科,云南保山678000 [2]云南省中医药大学第三附属医院外科,云南昆明650500 [3]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101

出　　处：《昆明医科大学学报》2023年第9期86-92,共7页Journal of Kunming Medical University

基　　金：云南省科技厅科技计划基金资助项目(202201AY070001-105);昆明医科大学研究生创新基金资助项目(2023S303)。

摘　　要：目的探讨在外科临床中极其常见的脾破裂患者中使用腔镜技术进行脾脏切除的优缺性。方法回顾分析云南省保山市第二人民医院在2012年5月至2022年10月期间普外科收治的外伤性脾破裂患者61例。所收集的资料中有25例患者行腹腔镜脾切除术(LS),将其纳入观察组;有36例患者行开腹手术(OS),将其纳入对照组。利用倾向性评分按1:1比例匹配,最终LS和OS各纳入25例。观察组(LS组)中男性患者16例,女性患者9例,年龄(43.92±21.24)岁,年龄范围在16~75岁;对照组(OS组)中男性患者19例,女性患者6例,年龄(35.20±16.28)岁,年龄范围在14~65岁。比较2组手术全期各项指标(出血量、术后镇痛时间、手术时间等)以及住院费用、术后并发症等。结果经过倾向性平分后2组基线资料满足可比性要求。LS组手术时间(157.16±43.47)min、腹腔积液98.00(50.00,100.00)mL、术中出血量800.00(500.00,1000.00)mL、术中输血量450.00(400.00,601.25)mL、术后首次排气(40.32±13.36)h、术后首次下床时间48.00(48.00,72.00)h、引流管拔除时间(72.96±21.33)h、术后镇痛时间24.00(24.00,48.00)h、住院时间12.00(10.00,14.00)d,优于OS组手术时间(184.20±63.14)min、积液量100.00 mL(100.00,200.00)、术中出血量1000.00(800.00,1750.00)mL、术中输血量1200.00(461.00,1200.00)mL、术后首次排气(58.56±18.43)h、术后首次下床时间72.00(48.00,120.00)h、引流管拔除时间(102.72±43.00)h、术后镇痛时间48.00(36.00,96.00)h、住院时间14(11.50,17.00)d,数据差异均有统计学意义(P<0.05)。LS组住院费用2.18(1.68,2.58)万元略高于OS组住院费用1.77(1.51,2.18)万元,但整体差距不大。结论LS在手术时间、术中控制出血量、术中输血量、术后排气、术后下床时间、镇痛药使用时间、腹腔积液、术后并发症等方面均相对于OS有优势,更加有利于患者恢复并且提升预后生存品质,更符合现代医学发展。Objective To investigate the advantages and disadvantages of laparoscopic splenectomy in patients with splenic rupture,which is very common in surgical practice.Methods The data of 61 patients with traumatic splenic rupture admitted to the Second People’s Hospital of Baoshan from May 2012 to October 2022 were retrospectively analyzed.Among the collected data,25 patients underwent laparoscopic splenectomy and were included in the observation group.Thirty-six patients underwent open surgery(OS)and were included in the control group.The orientation score was matched in 1∶1 ratio,and finally LS and OS were included in 25 cases each.In the observation group(LS group),there were 16 males and 9 females,aged(43.92±21.24)years old,ranging from 16 to 75 years old.In the control group(OS group),there were 19 male patients and 6 female patients,aged(35.20±16.28)years old,ranging from 14 to 65 years old.The indexes(blood loss,postoperative analgesic time,operation time,etc.),hospitalization cost and postoperative complications were compared between the two groups during the whole operation period.Results The baseline data of the two groups met the requirement of comparability after the propensity bisection.The operation time of LS group was(157.16±43.47)min,abdominal fluid was 98.00(50.00,100.00)mL,intraoperative blood loss was 800.00(500.00,1000.00)mL,intraoperative blood transfusion was 450.00(400.00,601.25)mL.The first postoperative exhaust was(40.32±13.36)h.The first time of getting out of bed after the operation was 48.00(48.00,72.00)h,drainage tube removal time was(72.96±21.33)h,and the postoperative analgesia time was 24.00(24.00,48.00)h.The hospital stay was 12.00(10.00,14.00)d,which was better than the operating time(184.20±63.14)min,with the effusion volume being 100.00(100.00,200.00)mL,intraoperative bleeding volume being 1000.00(800.00,1750.00)mL,intraoperative blood transfusion beting 1200.00(461.00,1200.00)mL.The first postoperative exhaust(58.56±18.43)h,first postoperative time of getting out of bed

关 键 词：脾破裂 腹腔镜脾切除术 开腹脾切除术 微创手术 

分 类 号：R657.62[医药卫生—外科学]