摘要
目的 探讨腹腔镜下二级脾蒂断离法脾切除术（LSSP）应用于治疗血吸虫性肝硬化引起的脾功能亢进患者切除脾脏的可行性、有效性、安全性和经济性等临床应用价值.方法 对2014年7月至2016年9月施行二级脾蒂断离法切除脾脏的30例血吸虫性肝硬化引起脾功能亢进患者的临床资料进行回顾性分析.结果 28例患者成功游离二级脾蒂并切除脾脏,2例患者应用直线切割闭合器断离脾蒂并切除脾脏.手术时间（80±20）min;28例患者术中出血（320±10）ml;术后拔出脾窝引流管时间（3~4）d;住院时间（10.8±1.2）d.术后均未出现大出血、胰漏、继发感染、膈下脓肿等严重并发症,并无切口感染等近期并发症.术后4天所有患者均出现血小板回升,患者血小板〉400＆#215;109/L时给予口服阿司匹林肠溶片处理;所有患者术后随访6个月,所有患者均未出现肠梗阻、门静脉血栓形成等远期并发症.结论 腹腔镜下二级脾蒂断离法切除血吸虫性肝硬化引起的脾功能亢进脾脏安全有效,缩短了住院时间,减少了医疗费用,值得临床应用推广.
Objective To investigate the feasibility, efficacy, safety and economy of secondary splenic pedicle trisection method in removing schistosoma cirrhosis caused the splenic function. Methods Thirty patients receiving spleen secondary structure amputation between July 2014 and September 2016 were analyzed. Results Laparoscopic splenectomy with secondary splenic pedicle transaction was successfully performed in 28 patients, whereas two Endo-GIAs were used in 2 patients. The average of operation time was （80 ± 20） min, and operative blood loss was （320 ± 10） ml. The drainage of the splenic fossa was removed （3- 4） days after operation.Postoperative hospital stay was （10.8 ± 1.2） days after operaions. No massive hemorrhage, pancreatic leakage, secondary infection, serious complications such as abscess under diaphragm and recent complication such as infection of incision occurred postoperatively. Platelet of all patients recovered in 4 days postoperatively, and patients with platelet〉400 ＆#215; 109/L was given oral aspirin enteric-coated metformin hydrochloride. All patients were followed up for 6 months postoperatively, and no intestinal obstruction, portal vein thrombosis and other long-term complications occurred in all patients. Conclusions The amputation of secondary structures of the spleen in laparoscopic splenectomy to remove schistosoma cirrhosis caused the splenic function is safe. It could shorten the length of hospital stay and reduce the medical cost. It is a valuable method for clinical promotion.
作者
杨晓丹
宋政炜
王晓光
倪全法
秦红波
余伟
费建国
Yang Xiaodan Song Zhengwei Wang Xiaoguang Ni Quanfa Qin Hongbo Yu Wei Fei Jianguo.(Department of Hepatobiliary Surgery, the Second Hospital Affiliated to Jiaxing University, Zhejiang Jiaxing 314000, China)
出处
《中国医师进修杂志》
2017年第6期539-541,共3页
Chinese Journal of Postgraduates of Medicine
