摘要
目的:探讨二级脾蒂精准离断腹腔镜脾切除术治疗创伤性脾破裂(TSR)的临床效果及安全性。方法:选取2023年1月—2024年11月新余市人民医院收治的80例TSR患者作为研究对象,按照手术方式分为参照组(采用传统腹腔镜脾切除术,n=39)和研究组(采用二级脾蒂精准离断腹腔镜脾切除术,n=41)。比较两组临床疗效、手术相关指标、血液指标、免疫功能及术后并发症发生率。结果:研究组总有效率为97.56%(40/41),高于参照组的69.23%(27/39),差异有统计学意义(P<0.05);研究组脾动脉结扎用时、住院时间、术后首次排气时间、首次进食时间均优于参照组,术中出血量少于参照组,差异有统计学意义(P<0.05);研究组引流量、Hb变化量、白蛋白变化量均小于参照组(P<0.05);术后1个月,两组IgG、IgA、IgM水平较术前下降,且研究组低于参照组,差异有统计学意义(P<0.05);研究组并发症总发生率为4.88%(2/41),与参照组的7.69%(3/39)比较,差异无统计学意义(P>0.05)。结论:二级脾蒂精准离断腹腔镜脾切除术治疗TSR具有显著效果,可缩短脾动脉结扎用时、住院、术后首次排气及首次进食时间,减少术中出血量、引流量、Hb变化量和白蛋白变化量,改善患者免疫功能,且具有相对较高的安全性。
Objective:To investigate the clinical effect and safety of laparoscopic splenectomy with precise secondary splenic pedicle dissection in the treatment of traumatic splenic rupture(TSR).Method:Eighty patients with TSR who were admitted to Xinyu People's Hospital from January 2023 to November 2024 were selected as the study subjects.They were divided into the reference group(traditional laparoscopic splenectomy,n=39)and the study group(laparoscopic splenectomy with precise secondary splenic pedicle dissection,n=41)according to the surgical method.The two groups were compared on clinical efficacy,surgery-related indicators,blood indexes,immune function,and the incidence of postoperative complications.Result:The total response rate in the study group was 97.56%(40/41),which was higher than 69.23%(27/39)in the reference group,the difference was statistically significant(P<0.05).The time for splenic artery ligation,length of hospital stay,postoperative first exhaust time and first feeding time in the study group were better than those in the reference group,the intraoperative blood loss in the study group was lower than that in the reference group,with statistically significant differences(P<0.05).The drainage volume and changes in Hb and albumin in the study group were smaller than those in the reference group,the differences were statistically significant(P<0.05).One month after surgery,the levels of IgG,IgA and IgM were decreased in both groups compared to preoperative levels,and the levels in study group were lower than those in the reference group,with statistically significant differences(P<0.05).The total incidence of complications in the study group was 4.88%(2/41),compared with 7.69%(3/39)in the reference group,there was no statistically significant difference(P>0.05).Conclusion:Laparoscopic splenectomy with precise secondary splenic pedicle dissection is effective for TSR.It can shorten the time of splenic artery ligation,the time of hospital stay,first postoperative exhaust and first meal intake,reduce intraoperative blood loss and drainage volume,the changes in Hb and albumin,enhance the immune function of patients,and has relatively high safety.
作者
杨锴
魏小勇
YANG Kai;WEI Xiaoyong(Trauma Emergency Center,Xinyu People's Hospital,Xinyu 338000,China;不详)
出处
《中国医学创新》
2025年第22期1-5,共5页
Medical Innovation of China
关键词
腹腔镜
二级脾蒂离断法
创伤性脾破裂
脾切除术
Laparoscopy
Secondary splenic pedicle dissection
Traumatic splenic rupture
Splenectomy
