不同脾蒂血管离断法在腹腔镜下脾切除术中的对比研究

发布时间：2018-10-29 10:12

【摘要】：目的探讨在腹腔镜下脾切除术(LS)中采用二级脾蒂血管离断(SSPD)法相比传统的一级脾蒂血管离断(PSPD)法的优势和局限,比较采用两种不同方法切除脾脏对患者体内免疫功能造成的影响大小。方法1.回顾性分析本科室2012年10月~2016年9月进行的85例LS患者的临床资料。所有患者按脾脏大小分为2组,在25例巨脾患者中,13例采用PSPD法,12例采用SSPD法;60名正常或中等大小脾脏患者中,28例采用PSPD法,32例采用SSPD法。通过比较采用两种方法施行LS的患者围手术期的数据,分析两种手术方法的疗效和经济效益。2.选取2015年1月~2016年9月间正常或中等大小脾脏患者中免疫功能正常或基本正常者23例,依据施行LS时所用手术方法的不同分为2组,11例采用PSPD法,12例采用SSPD法,检测两种方法行LS手术前后免疫相关指标的水平变化,并通过这种变化来分析两种不同方法的手术对人体的免疫功能造成的影响。结果1.所有85名患者中,80名患者完成了LS,5名患者中转开腹。在巨脾组中,采用PSPD法和SSPD法的LS患者中转率分别为7.9%和33.3%,并发症出现率分别为38.46%和16.67%,手术时间分别为170.35±58.36min和260.43±98.46min,术中出血分别为132.5±58.65mL和245.5±100.85mL,术后住院时间分别为4.5±1.3天和7.8±3.52天,输血量分别为1.53±1.02 U和3.28±1.48 U,手术费用分别为12856.76±1258.53元和8685.6±923.64元,上述指标差异均有统计学意义(P0.05)。在正常或中等大小脾脏组,除了并发症和手术费用之外,其他指标差异均无统计学意义(P0.05)。两组中,采用PSPD法和SSPD法的LS术后出现脾热以及胰瘘的几率均有明显差异。2.采用不同方法的两组中,IgM、IgA、C4含量在手术后均下降。其中Ig M水平于术后下降显著,降低程度有意义,而且至术后5d仍未恢复正常水平,但两组之间没有统计学差异(P0.05)。在PSPD法组中,术后1d IgG、C3的水平较术前下降显著,于术后5d恢复正常;在SSPD法组中,术后1d IgG、C3含量较术前降低,术后3d恢复正常,两组之间统计学差异(P0.05)。结论SSPD法可以减少脾热和胰瘘的发生率,降低手术费用,适用于正常或中等大小脾脏的LS。但由于其中转率高、手术风险高而不适用于巨脾患者。施行LS时采用SSPD法比PSPD法对人体的损伤小,术后的免疫抑制恢复快。
[Abstract]:Objective to explore the advantages and limitations of using secondary pedicle vascular dissection (SSPD) in laparoscopic splenectomy (LS) compared with the traditional (PSPD) method of primary pedicle splenectomy. The effect of two different methods on the immune function of patients was compared. Method 1. The clinical data of 85 patients with LS from October 2012 to September 2016 were analyzed retrospectively. All the patients were divided into two groups according to the size of spleen. Among 25 patients with giant spleen, 13 cases were treated with PSPD method, 12 cases with SSPD method, 28 cases with PSPD method and 32 cases with SSPD method. By comparing the data of patients with LS during perioperative period, the curative effect and economic benefit of the two methods were analyzed. 2. From January 2015 to September 2016, 23 patients with normal or normal immune function were divided into two groups according to the operative methods used in LS. 11 cases were treated with PSPD and 12 cases with SSPD. The changes of immune-related indexes before and after LS operation were detected, and the effects of two different methods on human immune function were analyzed. Result 1. Of the 85 patients, 80 had completed the conversion of LS,5 to open surgery. In the giant spleen group, the transfer rates of LS patients with PSPD and SSPD were 7.9% and 33.3%, respectively. The incidence of complications were 38.46% and 16.67%, respectively. The operative time was 170.35 卤58.36min and 260.43 卤98.46 minutes, respectively. Intraoperative bleeding was 132.5 卤58.65mL and 245.5 卤100.85mL, postoperative hospitalization time was 4.5 卤1.3days and 7.8 卤3.52days, blood transfusion volume was 1.53 卤1.02U and 3.28 卤1.48U, respectively. The cost of operation was 12856.76 卤1258.53 yuan and 8685.6 卤923.64 yuan respectively, the differences were statistically significant (P0.05). In normal or medium sized spleen group, there was no significant difference in other indexes except complications and operation cost (P0.05). The incidence of splenic fever and pancreatic fistula after LS with PSPD and SSPD were significantly different between the two groups. 2. 2. In the two groups with different methods, the content of IgM,IgA,C4 decreased after operation. The level of Ig M decreased significantly after operation, the degree of the decrease was significant, and did not return to normal level 5 days after operation, but there was no statistical difference between the two groups (P0.05). In the PSPD group, the level of IgG,C3 decreased significantly at 1 day after operation and returned to normal at 5 days after operation. In the SSPD group, the level of IgG,C3 decreased at 1 day after operation and returned to normal at 3 days after operation, and the difference between the two groups was statistically significant (P0.05). Conclusion SSPD method can reduce the incidence of splenic fever and pancreatic fistula, and reduce the cost of operation. It is suitable for LS. of normal or moderate spleen. However, because of its high transfer rate and high surgical risk, it is not suitable for patients with giant spleen. When LS was performed, SSPD method was less harmful than PSPD method, and the recovery of immunosuppression after operation was faster.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.6

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