术前DSA损伤分级在外伤性脾破裂行脾动脉栓塞治疗中的价值分析  

The Value of Preoperative DSA Injury Grading in the Treatment of Traumatic Splenic Rupture with Splenic Artery Embolization was Analyzed

作　　者：卢骏 牛万成 周峰 李磊 张召辉 LU Jun;NIU Wan-cheng;ZHOU Feng;LI Lei;ZHANG Shao-hui(General Surgery,Huaihai Hospital Affiliated to Xuzhou Medical University/Military Hospital of the 71st Army Group of the Chinese People's Liberation Army,Xuzhou,Jiangsu,221000,China)

机构地区：[1]中国人民解放军陆军第七十一集团军医院/徐州医科大学附属淮海医院普外科,江苏徐州221000

出　　处：《现代生物医学进展》2023年第20期3995-4000,共6页Progress in Modern Biomedicine

基　　金：江苏省科技项目合同(BK20211060)。

摘　　要：目的:分析术前DSA损伤分级在外伤性脾破裂行脾动脉栓塞治疗中的价值。方法:选取2020年1月-2022年12月本院收治的95例外伤性脾破裂患者进行研究,根据随机数字表法将其分为常规手术组(45例)和DSA引导下脾动脉栓塞组(50例),常规手术组行开腹脾全切术,DSA引导下脾动脉栓塞组在DSA引导下行脾动脉栓塞术,分析两组与DSA引导下脾动脉栓塞组不同DSA分级的手术相关指标、T淋巴细胞(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、免疫球蛋白(IgG、IgA、IgM)、白细胞(WBC)和血小板(PLT)含量及血清白介素6(IL-6)、血清白介素10(IL-10)、促吞噬素因子(Tuftsin)水平。结果:与常规手术组比较,DSA引导下脾动脉栓塞组手术时间、下床时间、住院时间较短,术中出血量较少(P<0.05)。术后14 d,与常规手术组比较,DSA引导下脾动脉栓塞组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较高,CD8^(+)水平较低(P<0.05)。术后14 d,与常规手术组比较,DSA引导下脾动脉栓塞组IgG、IgA、IgM水平较高(P<0.05)。术后14 d,与常规手术组比较,DSA引导下脾动脉栓塞组PLT含量较低;与DSAⅢ级比较,DSAⅠ-Ⅱ级PLT含量较低(P<0.05)。术后14 d,与常规手术组比较,DSA引导下脾动脉栓塞组血清IL-6水平较低,血清IL-10、Tuftsin水平较高(P<0.05)。结论:于DSA损伤分级指导下对外伤性脾破裂患者开展脾动脉栓塞术,对机体免疫功能造成的影响较小,且术中不会出现大量出血的情况,不仅能降低患者的血小板含量,还能促使患者尽快恢复。Objective:To analyze the value of preoperative DSA injury grading in splenic artery embolization for traumatic splenic rupture.Method:A total of 95 patients with traumatic splenic rupture admitted to our hospital from January 2020 to December 2022 were selected for study.According to the random number table method,they were divided into routine operation group(45 cases)and DSA-guided splenic artery embolization group(50 cases).The routine operation group underwent open total splenectomy,and the DSA-guided splenic artery embolization group underwent DSA-guided splenic artery embolization.The operation-related indexes,T lymphocytes(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),immunoglobulin(IgG,IgA,IgM),white blood cell(WBC)and platelet(PLT)contents,serum interleukin 6(IL-6),serum interleukin 10(IL-10)and tuftsin levels of different DSA grades in the two groups and DSA-guided splenic artery embolization group were analyzed.Results:Compared with the conventional operation group,the splenic artery embolization group under DSA guidance had shorter operation time,bed time and hospital stay,and less intraoperative blood loss(P<0.05).On postoperative day 14,compared with the conventional operation group,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the DSA-guided splenic artery embolization group were higher,and the levels of CD8^(+)were lower(P<0.05).On day 14 after surgery,the levels of IgG,IgA and IgM in the DSA-guided splenic artery embolization group were higher than those in the conventional operation group(P<0.05).At 14 days after operation,PLT content in the DSA-guided splenic artery embolization group was lower than that in the conventional operation group.Compared with DSAⅢ,the PLT content of DSAⅠ-Ⅱwas lower(P<0.05).On the 14 th day after operation,compared with the conventional operation group,the serum IL-6 level in the DSA-guided splenic artery embolization group was lower,and the serum IL-10 and Tuftsin levels were higher(P<0.05).Conclusion:Under the guidance of DSA injury grading,splenic artery emboliz

关 键 词：外伤性脾破裂 DSA损伤分级 脾动脉栓塞术 开腹脾全切术 免疫功能 

分 类 号：R657.62[医药卫生—外科学]