腹腔镜脾切除术治疗肝硬化所致脾功能亢进的临床研究

发布时间：2019-04-01 07:34

【摘要】：目的通过对腹腔镜脾切除手术与传统开腹脾切手术治疗肝硬化脾亢展开回顾性调查,收集相关临床资料并展开分析、进行对比。对肝硬化脾亢患者通过腹腔镜脾切除治疗的具体可行性、安全性以及该治疗技术存在的优势、不足之处进行探讨。方法回顾性分析安徽医科大学附属安庆市立医院普外科自2012年1月~2015年12月完成的23例腹腔镜肝硬化脾亢脾切除手术病例与同期有可比性的23例传统开腹肝硬化脾亢脾切除手术病例的临床资料。对比分析两组不同的临床资料(性别、平均年龄、平均体重等)、手术相关指标(如手术时间、切口疼痛程度、拔管时间、术后住院时间、脾脏大小)、肝功能、炎性反应、免疫功能等结果。结果两组均无围手术期死亡病例,腹腔镜组23例,无中转开腹病例,其中男性8例,女性15例;开腹组23例,其中男性10例,女性13例。对比分析一般临床资料,比如两组的平均体重、年龄、性别等具有可比性,P0.05,差异无统计学意义。手术指标包括:腹腔镜组的切口长度、引流管留置时间、术后住院时间、人均镇痛次数分别为4.86±0.49cm、4.77±1.52天、7.79±1.28天、1.91±0.67次;开腹组分别为15.54±1.30cm、6.76±2.41天、11.03±2.73天、4.00±0.85次。相较于传统的开腹手术组而言,上述指标腹腔镜组差异具有统计学意义(P0.05),明显减少。就平均手术时间来看,腹腔镜组、传统开腹组分别为101.38±26.25分钟、76.14±15.36分钟,差异具有统计学意义(P0.05),前者明显长于后者。另外在腹腔组手术中出血量、术中术后的输血量以及切除脾脏最大直径分别为156.42±36.43ml、243.48±119.95ml、15.88±1.23cm;开腹组分别为180.50±48.19ml、260.15±102.78ml、16.86±1.50cm,差异无统计学意义(P0.05)。术后发生并发症机率为:腹腔镜组13.04%,开腹组分别为17.39%,腹腔镜组均小于开腹组,但差异无统计学意义(P0.05)。肝功能:手术前1d,两组ALT、AST、Tbil、Dbil等指标比较,差异无统计学意义(P0.05);术后1d和7d,两组ALT、AST、Tbil、Dbil均高于术前,腔镜组低于开腹组,差异有统计学意义(P0.05)。炎症因子与免疫功能:手术前,两组WBC、CRP、CD4+、CD8+、CD4+/CD8+比较,差异无统计学意义(P0.05);术后1d和3d,两组WBC、CRP、CD8+均升高,CD4+、CD4+/CD8+降低,腔镜WBC、CRP、CD8+均低于开腹组,CD4+、CD4+/CD8+高于开腹组,差异有统计学意义(P0.05)。结论腹腔镜脾切除术治疗肝硬化所致脾功能亢进相比开腹手术具有优势,手术过程中切口较小,手术后切口恢复相对较快,引流管在体内留置的时间相对较短,住院时间缩短,能够有效降低炎症出现的几率。该项手术方法相比于以往开腹手同样安全可行,与以往开腹手术后的效果相同,但是手术时间相对较长,就长期疗效而言,还需后期通过随访得出结论。
[Abstract]:Objective to investigate retrospectively the clinical data of laparoscopic splenectomy and traditional open splenectomy in the treatment of liver cirrhosis hypersplenism. The feasibility, safety, advantages and disadvantages of laparoscopic splenectomy for patients with liver cirrhosis and hypersplenism were discussed. Methods from January 2012 to December 2015 in Anqing Municipal Hospital affiliated to Anhui Medical University, 23 cases of laparoscopic hypersplenectomy of liver cirrhosis and 23 cases of traditional open hepatocirrhosis were retrospectively analyzed and compared with those from January 2012 to December 2015 in the general surgery department of Anqing Municipal Hospital affiliated to Anhui Medical University. Clinical data of patients undergoing splenectomy for hypersplenism. Two groups of different clinical data (gender, mean age, average weight, etc.), surgical-related indicators (such as operation time, pain degree of incision, extubation time, postoperative hospital stay, spleen size), liver function, inflammatory reaction, and so on, were compared and analyzed between the two groups of clinical data (gender, mean age, average weight, etc.) Immune function, etc. Results there were no perioperative death cases in both groups, 23 cases in laparoscopy group, 8 cases in male and 15 cases in female, and 23 cases in laparotomy group, including 10 cases in male and 13 cases in female. Comparative analysis of general clinical data, such as the average weight, age, sex and other comparable, P0.05, there was no significant difference between the two groups. The operative indexes were: incision length, drainage tube indwelling time, postoperative hospital stay, average times of analgesia were 4.86 卤0.49 cm, 4.77 卤1.52 days, 7.79 卤1.28 days, 1.91 卤0.67 times, respectively. In the open group, 15.54 卤1.30cm, 6.76 卤2.41 days, 11.03 卤2.73 days, 4.00 卤0.85 times, respectively. Compared with the traditional laparotomy group, the above-mentioned indexes showed statistically significant difference (P0.05), significantly decreased. The average operation time was 101.38 卤26.25 minutes in laparoscopy group and 76.14 卤15.36 minutes in traditional laparotomy group, the difference was statistically significant (P0.05), the former was significantly longer than the latter. In the abdominal group, the volume of bleeding, the volume of blood transfusion and the maximum diameter of spleen resection were 156.42 卤36.43ml, 243.48 卤119.95ml, 15.88卤 1.23 cm;, respectively, in the abdominal group were 156.42 卤36.43ml, 243.48 卤119.95ml and 15.88卤 1.23 cm;. In the open group, 180.50 卤48.19 ml, 260.15 卤102.78 ml, 16.86 卤1.50 cm, respectively, there was no significant difference (P0.05). The incidence of postoperative complications was 13.04% in the laparoscopy group and 17.39% in the open group. The incidence of postoperative complications in the laparoscopy group was lower than that in the laparotomy group, but there was no significant difference (P0.05). Liver function: on the 1st day before operation, there was no significant difference in ALT,AST,Tbil,Dbil and other indexes between the two groups (P0.05). On the 1st and 7th day after operation, the ALT,AST,Tbil,Dbil of the two groups was higher than that of the preoperative group, and that of the laparoscopy group was lower than that of the open group (P0.05). Inflammatory factors and immune function: before operation, there was no significant difference in WBC,CRP,CD4, CD8, CD4 / CD8 between the two groups (P0.05); On the 1st and 3rd day after operation, WBC,CRP,CD8 increased, CD4, CD4 / CD8 decreased, endoscopic WBC,CRP,CD8 was lower, CD4, CD4 / CD8 were higher in the two groups than those in the open group (P0.05). Conclusion Laparoscopic splenectomy is superior to laparotomy in the treatment of hypersplenism caused by liver cirrhosis. The incision is smaller during the operation, and the incision recovers quickly after the operation. The time of indwelling the drainage tube in the body is relatively short and the hospitalization time is shorter than that of the laparoscopic splenectomy in the treatment of hypersplenism caused by cirrhosis. It can effectively reduce the incidence of inflammation. This method is as safe and feasible as the previous open hand, and the effect is the same as that after the previous open operation, but the operation time is relatively long. In terms of long-term curative effect, it is necessary to draw a conclusion through the follow-up at the later stage.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.31

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