腹腔镜脾切除术与开腹脾切除术治疗外伤性脾破裂的临床对比

发布时间：2018-10-24 11:03

【摘要】：目的：目前腹腔镜脾切除术应用广泛。该术式是治疗某些血液系统疾病的金标准。外伤性脾破裂的手术治疗往往采取开腹手术完成，但是随着外科医师手术经验的积累以及相关手术材料器械的改进，使腹腔镜脾切除术用于治疗外伤性脾破裂成为可能。目前国内外关于腹腔镜脾切除术治疗外伤性脾破裂的报道不多。本文通过比较两种手术病例的各项临床资料，，为外科医师在为外伤性脾破裂患者制定治疗方案时提供一定参考。方法：本文回顾性分析2013年08月至2015年3月于我院行腹腔镜脾切除术12例及开腹脾切除术15例患者临床资料，所有患者均为外伤性脾破裂。就两组患者的一般临床资料、术中出血量、手术时间、术后禁食水时间、术后应用镇痛药物次数、术后住院时间、住院费用、术后并发症等进行比较。计量资料采用独立样本t检验；计数资料采用四格表资料的Fisher确切概率法检验。P0.05代表差异具有统计学意义。结果：腹腔镜脾切除术组与开腹脾切除术组患者的一般临床资料，包括年龄、性别、自受伤至入院时间，无差异（P0.05）。LS组与OS组患者术中出血量、术后禁食水时间、术后应用镇痛药物次数、术后住院时间、住院费用无差异（P0.05）。LS组手术时间较OS组长（P0.05），OS组术后并发症发生率较LS高（P0.05）。结论：腹腔镜脾切除术用于治疗外伤性脾破裂是安全可行的。相对于开腹脾切除术，该术式有以下优势：1、腹腔镜治疗时可以进一步判断损伤程度，对于脾脏损伤较轻、出血较少的患者可以采取止血术，尽可能的保留脾脏，减少了开腹手术带来的巨大痛苦；2、腹腔镜下视野被放大，可清晰的观察到出血点，并确切止血；3、腹腔镜手术可探查下腹部其他脏器有无受损伤，而开腹脾切除术很难探查下腹部其他脏器。4、术后并发症少，创伤小。
[Abstract]:Objective: laparoscopic splenectomy is widely used at present. This procedure is the gold standard for the treatment of certain diseases of the blood system. The surgical treatment of traumatic splenic rupture is usually completed by open surgery, but with the accumulation of surgical experience and the improvement of related surgical materials and instruments, laparoscopic splenectomy is possible for the treatment of traumatic splenic rupture. There are few reports of laparoscopic splenectomy for traumatic splenic rupture at home and abroad. By comparing the clinical data of two kinds of surgical cases, this paper provides some references for surgeons in formulating treatment plans for patients with traumatic splenic rupture. Methods: the clinical data of 12 cases of laparoscopic splenectomy and 15 cases of open splenectomy in our hospital from August 2013 to March 2015 were retrospectively analyzed. The clinical data, intraoperative bleeding, time of operation, time of fasting water, times of application of analgesic drugs, hospitalization time, hospitalization cost and postoperative complications were compared between the two groups. The measurement data were tested by independent sample t test; the count data were tested by the Fisher exact probability method of four grid table data. P0.05 represents the difference has statistical significance. Results: there was no significant difference in general clinical data between laparoscopic splenectomy group and open splenectomy group, including age, sex, time from injury to admission. (P0.05) there was no significant difference between). LS group and OS group in blood loss during operation and time of fasting water after operation. There was no significant difference in the number of times of postoperative analgesic application, postoperative hospitalization time and hospitalization cost (P0.05 in). LS group compared with OS group (P0.05). The incidence of postoperative complications in), OS group was higher than that in LS group (P0.05). Conclusion: laparoscopic splenectomy is safe and feasible for the treatment of traumatic splenic rupture. Compared with open splenectomy, this procedure has the following advantages: 1. Laparoscopic treatment can further judge the degree of injury. For patients with mild splenic injury and less bleeding, hemostasis can be used to preserve the spleen as much as possible. It reduces the pain caused by laparotomy; 2, the visual field of laparoscopy is enlarged, the bleeding spot can be clearly observed, and the bleeding is stopped. 3, laparoscopy can detect any damage to other organs in the lower abdomen. However, open splenectomy is difficult to explore other lower abdominal organs. 4.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.6

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