腹腔鏡脾切除術(shù)治療肝硬化所致脾功能亢進的臨床研究
發(fā)布時間：2019-04-01 07:34
【摘要】：目的通過對腹腔鏡脾切除手術(shù)與傳統(tǒng)開腹脾切手術(shù)治療肝硬化脾亢展開回顧性調(diào)查,收集相關(guān)臨床資料并展開分析、進行對比。對肝硬化脾亢患者通過腹腔鏡脾切除治療的具體可行性、安全性以及該治療技術(shù)存在的優(yōu)勢、不足之處進行探討。方法回顧性分析安徽醫(yī)科大學附屬安慶市立醫(yī)院普外科自2012年1月~2015年12月完成的23例腹腔鏡肝硬化脾亢脾切除手術(shù)病例與同期有可比性的23例傳統(tǒng)開腹肝硬化脾亢脾切除手術(shù)病例的臨床資料。對比分析兩組不同的臨床資料(性別、平均年齡、平均體重等)、手術(shù)相關(guān)指標(如手術(shù)時間、切口疼痛程度、拔管時間、術(shù)后住院時間、脾臟大小)、肝功能、炎性反應、免疫功能等結(jié)果。結(jié)果兩組均無圍手術(shù)期死亡病例,腹腔鏡組23例,無中轉(zhuǎn)開腹病例,其中男性8例,女性15例;開腹組23例,其中男性10例,女性13例。對比分析一般臨床資料,比如兩組的平均體重、年齡、性別等具有可比性,P0.05,差異無統(tǒng)計學意義。手術(shù)指標包括:腹腔鏡組的切口長度、引流管留置時間、術(shù)后住院時間、人均鎮(zhèn)痛次數(shù)分別為4.86±0.49cm、4.77±1.52天、7.79±1.28天、1.91±0.67次;開腹組分別為15.54±1.30cm、6.76±2.41天、11.03±2.73天、4.00±0.85次。相較于傳統(tǒng)的開腹手術(shù)組而言,上述指標腹腔鏡組差異具有統(tǒng)計學意義(P0.05),明顯減少。就平均手術(shù)時間來看,腹腔鏡組、傳統(tǒng)開腹組分別為101.38±26.25分鐘、76.14±15.36分鐘,差異具有統(tǒng)計學意義(P0.05),前者明顯長于后者。另外在腹腔組手術(shù)中出血量、術(shù)中術(shù)后的輸血量以及切除脾臟最大直徑分別為156.42±36.43ml、243.48±119.95ml、15.88±1.23cm;開腹組分別為180.50±48.19ml、260.15±102.78ml、16.86±1.50cm,差異無統(tǒng)計學意義(P0.05)。術(shù)后發(fā)生并發(fā)癥機率為:腹腔鏡組13.04%,開腹組分別為17.39%,腹腔鏡組均小于開腹組,但差異無統(tǒng)計學意義(P0.05)。肝功能:手術(shù)前1d,兩組ALT、AST、Tbil、Dbil等指標比較,差異無統(tǒng)計學意義(P0.05);術(shù)后1d和7d,兩組ALT、AST、Tbil、Dbil均高于術(shù)前,腔鏡組低于開腹組,差異有統(tǒng)計學意義(P0.05)。炎癥因子與免疫功能:手術(shù)前,兩組WBC、CRP、CD4+、CD8+、CD4+/CD8+比較,差異無統(tǒng)計學意義(P0.05);術(shù)后1d和3d,兩組WBC、CRP、CD8+均升高,CD4+、CD4+/CD8+降低,腔鏡WBC、CRP、CD8+均低于開腹組,CD4+、CD4+/CD8+高于開腹組,差異有統(tǒng)計學意義(P0.05)。結(jié)論腹腔鏡脾切除術(shù)治療肝硬化所致脾功能亢進相比開腹手術(shù)具有優(yōu)勢,手術(shù)過程中切口較小,手術(shù)后切口恢復相對較快,引流管在體內(nèi)留置的時間相對較短,住院時間縮短,能夠有效降低炎癥出現(xiàn)的幾率。該項手術(shù)方法相比于以往開腹手同樣安全可行,與以往開腹手術(shù)后的效果相同,但是手術(shù)時間相對較長,就長期療效而言,還需后期通過隨訪得出結(jié)論。
[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 鹵0.49 cm, 4.77 鹵1.52 days, 7.79 鹵1.28 days, 1.91 鹵0.67 times, respectively. In the open group, 15.54 鹵1.30cm, 6.76 鹵2.41 days, 11.03 鹵2.73 days, 4.00 鹵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 鹵26.25 minutes in laparoscopy group and 76.14 鹵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 鹵36.43ml, 243.48 鹵119.95ml, 15.88鹵 1.23 cm;, respectively, in the abdominal group were 156.42 鹵36.43ml, 243.48 鹵119.95ml and 15.88鹵 1.23 cm;. In the open group, 180.50 鹵48.19 ml, 260.15 鹵102.78 ml, 16.86 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.31
[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 鹵0.49 cm, 4.77 鹵1.52 days, 7.79 鹵1.28 days, 1.91 鹵0.67 times, respectively. In the open group, 15.54 鹵1.30cm, 6.76 鹵2.41 days, 11.03 鹵2.73 days, 4.00 鹵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 鹵26.25 minutes in laparoscopy group and 76.14 鹵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 鹵36.43ml, 243.48 鹵119.95ml, 15.88鹵 1.23 cm;, respectively, in the abdominal group were 156.42 鹵36.43ml, 243.48 鹵119.95ml and 15.88鹵 1.23 cm;. In the open group, 180.50 鹵48.19 ml, 260.15 鹵102.78 ml, 16.86 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.31
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