腹腔镜脾切除与开腹脾切除的疗效观察

目的探讨腹腔镜脾切除治疗非外伤性脾肿大的可行性与安全性。方法选取我院2009年1月至2013年6月因非外伤性脾肿大而进行脾切除的患者40例,其中22例行腹腔镜脾切除术为腹腔镜(LS)组,18例行传统开腹的脾切除术作为开腹组(OS),观察两组围手术期的相关指标,并进行对比分析。结果LS组中2例(9.1%)患者因术中出血而中转开腹,6例患者于腔镜下同时行门奇静脉断流术,4例患者于腔镜下同时行胆囊切除术。OS组中7例患者同时行门奇静脉断流术,3例患者同时行胆囊切除术。两组患者的脾重量、体积以及长度均无统计学意义(P值>0.05)。LS组的平均手术时间长于OS组,但LS组术中失血量和术中输血的例数均也少于OS组,差异均有统计学意义(P值<0.05)。LS组术后平均住院时间为7.6±1.8(d),小于OS组的10.1±2.1(d),差异有统计学意义(P值<0.01)。LS组术后并发症率为18.2%,要低于OS组的38.9%(P<0.05),两组均无死亡病例。结论腹腔镜脾切除术治疗非外伤性脾肿大是安全可行的。

Observation of therapeutic efficacy on laparoscopic and open splenectomy

Objective To investigate the feasibility, safety and the therapeutic efficacy of laparoscopic splenectomy in nontraumatic splenomegaly. Methods The clinical data were selected from January 2009 to June 2013 in our hospital. Forty patients underwent laparoscopic or open splenectomy for nontraumatic splenomegaly. Among 40 cases, 22 cases received laparoscopic splenectomy as laparoscope group （LS）, the other 18 cases received traditional open splenectomy as the operation group （OS）. The perioperative indexes of the two groups were observed and analyzed. Results In the LS group, 2 cases （9.1%） were converted to open splenectomy due to bleeding during operation, 6 cases received simultaneously laparoscopic porta-azygous devascularization, 4 cases received simultaneously laparoscopic cholecystectomy. While in the OS group, 7 cases underwent simultaneously porta-azygous devascularization, 3 cases underwent simultaneously cholecystectomy. The spleen weight, volume and length were not statistically significant （P〉0.05） between two groups. Although the average operative time of LS was longer than that of OS, but the intraoperative blood loss and blood transfusion of LS were less than that of OS, the differences were statistically significant （P〈 0.05）. The mean postoperative hospital stay of LS was 7.6＋1.8 （d）, and was less than that of OS 10.1：t： 2.1 （d）, the difference was statistically significant （P〈0.01）. The postoperative complication rate of LS was lower than that of OS （18.2% vs 38.9%, P〈0.05）. There were no dead case in two groups. Conclusion Laparoscopic splenectomy for non-traumatic splenomegaly is feasible, safe.