【摘要】：目的探討在腹腔鏡下脾切除術(shù)(LS)中采用二級脾蒂血管離斷(SSPD)法相比傳統(tǒng)的一級脾蒂血管離斷(PSPD)法的優(yōu)勢和局限,比較采用兩種不同方法切除脾臟對患者體內(nèi)免疫功能造成的影響大小。方法1.回顧性分析本科室2012年10月~2016年9月進(jìn)行的85例LS患者的臨床資料。所有患者按脾臟大小分為2組,在25例巨脾患者中,13例采用PSPD法,12例采用SSPD法;60名正�；蛑械却笮∑⑴K患者中,28例采用PSPD法,32例采用SSPD法。通過比較采用兩種方法施行LS的患者圍手術(shù)期的數(shù)據(jù),分析兩種手術(shù)方法的療效和經(jīng)濟效益。2.選取2015年1月~2016年9月間正�；蛑械却笮∑⑴K患者中免疫功能正�；蚧菊Ｕ�23例,依據(jù)施行LS時所用手術(shù)方法的不同分為2組,11例采用PSPD法,12例采用SSPD法,檢測兩種方法行LS手術(shù)前后免疫相關(guān)指標(biāo)的水平變化,并通過這種變化來分析兩種不同方法的手術(shù)對人體的免疫功能造成的影響。結(jié)果1.所有85名患者中,80名患者完成了LS,5名患者中轉(zhuǎn)開腹。在巨脾組中,采用PSPD法和SSPD法的LS患者中轉(zhuǎn)率分別為7.9%和33.3%,并發(fā)癥出現(xiàn)率分別為38.46%和16.67%,手術(shù)時間分別為170.35±58.36min和260.43±98.46min,術(shù)中出血分別為132.5±58.65mL和245.5±100.85mL,術(shù)后住院時間分別為4.5±1.3天和7.8±3.52天,輸血量分別為1.53±1.02 U和3.28±1.48 U,手術(shù)費用分別為12856.76±1258.53元和8685.6±923.64元,上述指標(biāo)差異均有統(tǒng)計學(xué)意義(P0.05)。在正常或中等大小脾臟組,除了并發(fā)癥和手術(shù)費用之外,其他指標(biāo)差異均無統(tǒng)計學(xué)意義(P0.05)。兩組中,采用PSPD法和SSPD法的LS術(shù)后出現(xiàn)脾熱以及胰瘺的幾率均有明顯差異。2.采用不同方法的兩組中,IgM、IgA、C4含量在手術(shù)后均下降。其中Ig M水平于術(shù)后下降顯著,降低程度有意義,而且至術(shù)后5d仍未恢復(fù)正常水平,但兩組之間沒有統(tǒng)計學(xué)差異(P0.05)。在PSPD法組中,術(shù)后1d IgG、C3的水平較術(shù)前下降顯著,于術(shù)后5d恢復(fù)正常;在SSPD法組中,術(shù)后1d IgG、C3含量較術(shù)前降低,術(shù)后3d恢復(fù)正常,兩組之間統(tǒng)計學(xué)差異(P0.05)。結(jié)論SSPD法可以減少脾熱和胰瘺的發(fā)生率,降低手術(shù)費用,適用于正�；蛑械却笮∑⑴K的LS。但由于其中轉(zhuǎn)率高、手術(shù)風(fēng)險高而不適用于巨脾患者。施行LS時采用SSPD法比PSPD法對人體的損傷小,術(shù)后的免疫抑制恢復(fù)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 鹵58.36min and 260.43 鹵98.46 minutes, respectively. Intraoperative bleeding was 132.5 鹵58.65mL and 245.5 鹵100.85mL, postoperative hospitalization time was 4.5 鹵1.3days and 7.8 鹵3.52days, blood transfusion volume was 1.53 鹵1.02U and 3.28 鹵1.48U, respectively. The cost of operation was 12856.76 鹵1258.53 yuan and 8685.6 鹵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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.6

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