摘要
目的评估腹腔镜脾部分切除术(laparoscopic partial splenectomy,LPS)在脾良性占位性病变手术治疗中的效果及安全性。方法分析华中科技大学同济医学院附属协和医院自2018年1月至2023年7月收治的85例脾良性占位性病变病人的临床资料,根据手术方式分为两组,25例行LPS的病人为LPS组,60例行腹腔镜全脾切除术(laparoscopic total splenectomy,LTS)的病人为LTS组。统计比较两组术前、术中、术后指标以及并发症(腹腔积液、感染、静脉血栓形成、血小板增多症等)发生率。结果两组病人均顺利完成手术。LPS组与LTS组比较,术后引流时间[(4.6±1.6)d比(5.9±1.6)d]、术后通气时间[(1.4±0.5)d比(1.9±0.8)d]、术后活动时间[(2.6±0.5)d比(3.1±0.8)d]及术后住院时间[(6.3±1.5)d比(7.8±3.1)d]均缩短,且术后第1、3天白细胞计数[(10.2±2.1)×10^(9)/L比(14.7±4.1)×10^(9)/L、(9.5±3.3)×10^(9)/L比(13.3±3.8)×10^(9)/L]及术后第1、3天血小板计数[(172.8±57.9)×10^(9)/L比(203.0±61.3)×10^(9)/L、(210.1±112.5)×10^(9)/L比(298.0±125.9)×10^(9)/L]LPS组均低于LTS组,差异均有统计学意义(均P<0.05);但两组的手术时间、术中出血量、术后引流量、红细胞计数、血红蛋白水平及白蛋白水平比较差异均无统计学意义(均P>0.05)。此外,LPS组术后并发症发生率显著低于LTS组[4.0%(1/25)比30.0%(18/60)],差异有统计学意义(χ^(2)=5.457,P<0.05)。结论LPS是一种疗效确切、安全可行的手术方式,在脾良性占位性病变的临床诊疗中具有重要价值,建议在有条件的医疗中心进行推广。
Objective To evaluate the efficacy and safety of laparoscopic partial splenectomy(LPS)in the surgical treatment of splenic benign lesions.Methods Between January 2018 and July 2023,the relevant clinical data of 85 patients with splenic benign lesions were retrospectively analyzed.Based upon surgical approaches,they were assigned into two groups of LPS(n=25)and LTS group(n=60)according to the surgical methods.The related perioperative parameters were recorded.The incidence of complications(abdominal fluid accumulation,infection,venous thrombosis&thrombocytosis,etc.)were compared between two groups.Results All operation were successfully completed.Postoperative drainage time[(4.6±1.6)vs.(5.9±1.6)day],postoperative ventilation time[(1.4±0.5)vs.(1.9±0.8)day],postoperative activity time[(2.6±0.5)vs.(3.1±0.8)day]and postoperative hospitalization stay[(6.3±1.5)vs.(7.8±3.1)days]were shorter in LPS group than those in LTS group.White blood cell count[(10.2±2.1)×10^(9)/L vs.(14.7±4.1)×10^(9)/L,(9.5±3.3)×10^(9)/L vs.(13.3±3.8)×10^(9)/L]and platelet count[(172.8±57.9)×10^(9)/L vs.(203.0±61.3)×10^(9)/L,(210.1±112.5)×10^(9)/L vs.(298.0±125.9)×10^(9)/L]were lower in LPS group than those in LTS group at Day 1/3 post-operation.There were statistically significant differences(all P<0.05).However,no significant inter-group differences existed in operative duration,intraoperative volume of blood loss,postoperative drainage volume,red blood cell count or hemoglobin/albumin level(all P>0.05).In addition,the incidence of postoperative complications was significantly lower in LPS group than that in LTS group[4.0%(1/25)vs.30.0%(18/60)]and the difference was statistically significant(χ^(2)=5.457,P<0.05).Conclusion As an effective,safe and feasible surgery,LPS has an important value in the clinical management of splenic benign lesions.It is recommended for wider popularization at qualified medical centers.
作者
王茜
曹国军
柴新群
Wang Xi;Cao Guojun;Chai Xinqun(Department of Hepatobiliary Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430022,China)
出处
《腹部外科》
2024年第3期200-206,共7页
Journal of Abdominal Surgery
基金
国家重点研发计划(2022YFC2407402)。
