腹腔鏡脾切除術與開腹脾切除術治療外傷性脾破裂的臨床對比
發(fā)布時間：2018-10-24 11:03
【摘要】：目的： 目前腹腔鏡脾切除術應用廣泛。該術式是治療某些血液系統(tǒng)疾病的金標準。外傷性脾破裂的手術治療往往采取開腹手術完成，但是隨著外科醫(yī)師手術經(jīng)驗的積累以及相關手術材料器械的改進，使腹腔鏡脾切除術用于治療外傷性脾破裂成為可能。目前國內(nèi)外關于腹腔鏡脾切除術治療外傷性脾破裂的報道不多。本文通過比較兩種手術病例的各項臨床資料，，為外科醫(yī)師在為外傷性脾破裂患者制定治療方案時提供一定參考。 方法： 本文回顧性分析2013年08月至2015年3月于我院行腹腔鏡脾切除術12例及開腹脾切除術15例患者臨床資料，所有患者均為外傷性脾破裂。就兩組患者的一般臨床資料、術中出血量、手術時間、術后禁食水時間、術后應用鎮(zhèn)痛藥物次數(shù)、術后住院時間、住院費用、術后并發(fā)癥等進行比較。計量資料采用獨立樣本t檢驗；計數(shù)資料采用四格表資料的Fisher確切概率法檢驗。P0.05代表差異具有統(tǒng)計學意義。 結果： 腹腔鏡脾切除術組與開腹脾切除術組患者的一般臨床資料，包括年齡、性別、自受傷至入院時間，無差異（P0.05）。LS組與OS組患者術中出血量、術后禁食水時間、術后應用鎮(zhèn)痛藥物次數(shù)、術后住院時間、住院費用無差異（P0.05）。LS組手術時間較OS組長（P0.05），OS組術后并發(fā)癥發(fā)生率較LS高（P0.05）。 結論： 腹腔鏡脾切除術用于治療外傷性脾破裂是安全可行的。相對于開腹脾切除術，該術式有以下優(yōu)勢：1、腹腔鏡治療時可以進一步判斷損傷程度，對于脾臟損傷較輕、出血較少的患者可以采取止血術，盡可能的保留脾臟，減少了開腹手術帶來的巨大痛苦；2、腹腔鏡下視野被放大，可清晰的觀察到出血點，并確切止血；3、腹腔鏡手術可探查下腹部其他臟器有無受損傷，而開腹脾切除術很難探查下腹部其他臟器。4、術后并發(fā)癥少，創(chuàng)傷小。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.6
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.6
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