腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响

目的探讨腹腔镜脾切除术治疗巨脾症的临床疗效及其对病人应激反应的影响。方法将汉川市人民医院2013年1月至2016年6月收治的38例巨脾症病人作为临床研究对象,根据其治疗方式,将19例行腹腔镜脾切除术(laparoscopic splenectomy,LS)病人纳入LS组,19例行开腹脾切除术(open splenectomy,OS)病人纳入OS组,记录两组病人手术切口长度、手术时间、术中出血量、肠功能恢复时间、住院时间及术后并发症发生情况,并检测两组病人术前1 d、术后1 d及7 d C反应蛋白(C-reactive protem,CRP)、降钙素原(procalcitonin,PCT)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)等应激反应指标并观察其变化,给予统计学分析后得出结论。结果除手术时间外,在手术切口长度、术中出血量、住院时间、肠道功能恢复时间、术后并发症发生率等比较中,LS组均优于OS组,差异均有统计学意义(P0.05)。在应激反应指标方面,两组病人术后1 d CRP、PCT、IL-6、TNF-α均明显升高,术后7d均明显降低,但两组病人之间比较,LS组术前1d与OS组差异无统计学意义,术后1 d、7 d均明显低于OS组,差异均有统计学意义(P0.05)。结论在巨脾症的临床治疗中,LS对病人术中侵袭度小,术后恢复快,对病人应激反应影响小,术后并发症少。     

手助腹腔镜与开腹巨脾切除术的临床对比研究

目的对比手助腹腔镜与开腹手术治疗巨脾症的临床疗效。方法 2006年8月～2011年6月,将40例巨脾按患者意愿分成2组各20例,分别进行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)和传统开腹脾切除术(open splenectomy,OS),比较两组的手术时间、术中出血量、术后肛门排气时间、术后并发症发生率及术后住院时间等。结果 20例HALS组手术均获得成功,无中转开腹。与OS组相比,HALS组手术时间长[(110.9±37.2)min vs.(80.2±20.7)min,t=3.225,P=0.003],术中出血量少[(205.2±70.7)ml vs.(390.7±175.1)ml,t=-4.393,P=0.000],术后肛门排气早[(1.8±0.6)d vs.(2.4±0.9)d,t=-2.481,P=0.018],术后住院时间短[(8.9±1.2)d vs.(10.9±1.8)d,t=-4.134,P=0.000],术后并发症发生率差异无显著性[0(0例)vs.5.0%(1例),P=1.000]。结论 相比开腹手术,手助腹腔镜巨脾切除术具有切口美观、创伤小、恢复快的优点,是一种安全可行的治疗巨脾症的手术方式。     

手助腹腔镜巨脾切除术临床分析

目的探讨对巨脾行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)的可行性、安全性和手术技巧。方法2005年1月~2006年12月,对门脉高压性巨脾40例,采用HALS(n=15)或开腹脾切除(open splenectomy,OS)(n=25)。2组年龄、性别、肝功能分级、脾脏大小相似。结果2组未发生严重手术并发症。与OS组相比,HALS组术中出血多[(312±61)ml vs(235±105)ml,t=2.583,P=0.014],手术时间长[(95±20)min vs(73±16)min,t=3.832,P=0.000],术后肠功能恢复早[(48±1)h vs(98±1)h,t=-153.093,P=0.000],术后住院时间短[(6±2)d vs(10±2)d,t=-6.124,P=0.000)]。结论手助腹腔镜巨大脾脏切除是安全、可行的。与开腹脾脏切除相比,虽然手术时间长,但是术后恢复快、住院时间短。     

手助腹腔镜与开腹脾切除、贲门周围血管离断术的临床分析

目的 探讨肝硬化门脉高压症继发食管胃底静脉曲张、脾功能亢进患者行手助腹腔镜(hand-assisted laparoscopic surgery,HALS)脾切除、贲门周围血管离断术与开腹脾切除、贲门周围血管离断术(open splenectomy,OS)的肝功能变化及临床疗效.方法 回顾分析2002年1月至2008年5月施行脾切除责门周围血管离断术治疗肝硬化门静脉高压症94例,其中手助腹腔镜手术(HALS组)38例,开腹手术(OS组)56例.术前按Child法进行肝功能分级,对比分析两组手术时间、术中失血、术后并发症发生率、肝功能损害和病死率.结果 手助腹腔镜组与开腹组两组手术用时差异无显著性(P＞0.05);术中平均出血量、并发症发生率分别为5.6%和10.8%,差异有统计学意义(P＜0.05);两组术后ALT比较差异无统计学意义,ALB比较差异有统计学意义(P＜0.05),AST第5天比较差异有统计学意义(P＜0.05);HALS组ALT、AST术后均较术前升高,但只有AST升高有统计学意义(P＜0.05);OS组ALT、AST术后均比术前显著升高,差异均有统计学意义(P＜0.05);两组ALB术后均比术前降低,OS组差异均有统计学意义(P＜0.05),HALS组仅第1、3天差异有统计学意义(P＜0.05).结论 手助腹腔镜脾切除、贲门周围血管离断术对肠道和肝功能影响较开腹组小,术后并发症少,是安全可行的.

Abstract：

Objective To investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. Methods The clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. Results There was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. Conclusions Compared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.     

脾门先离断技术用于手助腹腔镜脾切除与断流术治疗门静脉高压症

腹腔镜脾切除尤其巨脾切除,是难度、风险均较大的手术。手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)用于巨脾切除,可极大地增加手术的安全性,缩短手术时间,减少并发症的发生[1]。笔者近年在HALS时发现,脾蒂与其外侧的腹膜之间为疏松间隙,打开胃结肠韧带后,用手指很易在脾蒂后方的间隙中分离,将手指从其     

手助腹腔镜及开腹脾切除巨脾的临床疗效比较

目的比较手助腹腔镜(HALS)和开腹切除(OP)巨脾的临床效果。方法回顾性分析2004年—2010年行脾切除术患者的临床资料,比较其中大于20 cm脾脏行HALS和OP的临床疗效。结果大于20 cm的巨脾切除术患者41例,21例为HALS手术,20例为开腹脾切除手术。HALS组的中转开腹率4.7%。HALS和OP组的平均出血量为227 mL和887 mL(P=0.01),平均输血为0和0.6单位(P<0.05)。HALS组的住院时间比OP显著为短(4.3 d vs.8.4 d)(P=0.001)。并发症发生率两者相比无统计学差异(P>0.05)。结论 HALS是一项安全和有效的巨脾(大于20 cm)切除技术。相比开腹脾切除其住院时间更短,出血及输血更少,是一种行之有效的替代方法。     

手助腹腔镜脾切除与开腹脾切除对机体术后免疫功能影响的比较

目的研究手助腹腔镜脾切除术和开腹脾切除对机体免疫功能的影响,考察该术式的临床价值。方法16例肝硬化脾亢患者随机分为手助腹腔镜脾切除组和开腹脾切除组,比较两组病例术前、术后1d、3d、7d外周血淋巴细胞亚群的变化。结果开腹组术后1d、3d、7d的成熟淋巴细胞(CD3)、辅助淋巴细胞(CD4)及CD4与抑制性T淋巴细胞(CD8)的比值与术前相比明显下降(P<0.05或P<0.01)。而腹腔镜组术后1d、3d、7d的CD3、CD4、CD4/CD8与术前相比没有显著差异(P>0.05)。结论手助腹腔镜脾切除术结合了微创外科和传统开腹手术的优点,具有安全、创伤小、恢复快的特点,具有很好的临床应用价值和前景。     

手助腹腔镜技术在巨脾切除中的应用

目的:探讨手助腹腔镜技术在巨脾切除术中的应用。方法:用手助腹腔镜技术实施1例巨脾切除术。结果:顺利完成手助腹腔镜巨脾切除,手术时间3h,术中失血30ml,切除脾脏约40cm×15cm×10cm大小,未中转开腹,无术中术后并发症发生,住院7d,治愈出院。结论:手助腹腔镜脾切除术对于巨脾是可行的、安全的,而且保留了微侵袭外科恢复快的优点,为组织学检查提供足够大的标本。     

手助腹腔镜脾切除与开腹脾切除治疗巨脾效果比较

比较手助腹腔镜脾切除与开腹脾切除治疗巨脾的效果。回顾性分析41例因巨脾行脾脏切除术的临床资料。手助腹腔镜脾切除术患者23例,开腹脾切除术患者18例。比较两组患者手术时间、术中出血量、术后平均住院时间、术后并发症发生率。结果显示,与开腹脾切除术相比,手助腹腔镜脾切除的手术时间长[(313+41.8)min vs(209+19.9)min,P=0.01]、术中出血量少[(324±54.8)ml vs(539±154.8)mL,P=0.01]、术后并发症少(P=0.004)、术后平均住院时间短[(6±1.2)d vs(9±1.4)d,P=0.01]。结果表明,与开腹脾切除术相比,手助腹腔镜脾切除的手术出血量少,术后并发症发生率低,术后住院时间更短,但手术时间长。     

手助腹腔镜与开腹脾切除加门-奇静脉阻断术的前瞻性对比研究

目的 :探讨手助腹腔镜脾切除加门 -奇静脉阻断术的可行性及优越性。方法 :随机将肝硬化并门静脉高压 5 0例分为 2组 ,2 5例行手助腹腔镜脾切除加门 -奇静脉阻断术 ,2 5例行开腹手术 ,比较 2组的手术时间、术中出血量 ,术后住院时间 ,术后肛门排气时间 ,术后并发症 ,术前及术后 1～3d每日晨血清胃动素、C反应蛋白 (CRP)、肿瘤坏死因子 (TNF)及白细胞介素 6 (IL 6 )的动态变化。结果 :2 5例手助腹腔镜脾切除加门 -奇静脉阻断术获得成功 ,术中术后无并发症发生。与开腹组比较 ,除手术时间差异无显著性外 ,其余各项指标差异均有显著性 (P <0 0 5 ) ,手助腹腔镜组术中出血少 ,术后胃动素高峰值提前肛门排气时间早 ,术后并发症少 ,术后住院时间短 ,开腹组术后第 1天和 (或 )第 3天CRP、IL 6、TNF均较术前升高 (P <0 0 1) ;手助腹腔镜组创伤反应比开腹组低 (P <0 0 1)。结论 :手助腹腔镜脾切除加门 -奇静脉阻断术安全可行的 ,且比开腹手术有优越性。     

手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的应用价值分析

目的：探讨手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的临床应用价值,并为其临床应用提供依据。方法：共纳入52例确诊为门脉高压的患者,均行脾切除加门奇断流术,采用随机数字法平均分为观察组与对照组,观察组患者行手辅助腹腔镜手术,对照组患者行开腹手术。观察两组患者手术出血量、手术时间、住院时间等,并分析其对机体应激反应（TNF-α,IL-6,CRP）的影响。结果：观察组术中出血量、手术时间及术后引流量、引流时间、肛门排气时间、住院时间明显少于对照组,差异有统计学意义（P〈0．05）;对照组切脾最大直径大于观察组,但差异无统计学意义（P〉0．05）。术后观察组患者CRP、IL-6、TNF-α水平均明显低于对照组,差异有统计学意义（P〈0．05）。结论：手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者具有较好的临床疗效,可减少术中出血量、术后引流量,缩短手术时间、住院时间,机体应激反应较小。     

Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre

Background

Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon’s hand in the abdomen during the operation. In this study, we compared the HALS technique to standard open splenectomy for the management of massive splenomegaly.

Methods

We reviewed all splenectomies performed at 5 hospitals in the greater Vancouver area between 1988 and 2007 for multiple demographic and outcome measures. Open splenectomies were compared with HALS procedures for spleens larger than 20 cm. Splenectomy reports without data on spleen size were excluded from the analysis. We performed Student t tests and Pearson χ² statistical analyses.

Results

A total of 217 splenectomies were analyzed. Of these, 39 splenectomies were performed for spleens larger than 20 cm. We compared the open splenectomy group (19 patients) with the HALS group (20 patients). There was a 5% conversion rate in the HALS group. Estimated blood loss (375 mL v. 935 mL, p = 0.08) and the mean (and standard deviation [SD]) transfusion rates (0.0 [SD 0.0] units v. 0.8 [SD 1.7] units, p = 0.06) were lower in the HALS group. Length of stay in hospital was significantly shorter in the HALS group (4.2 v. 8.9 d, p = 0.001). Complication rates were similar in both groups.

Conclusion

Hand-assisted laparoscopic splenectomy is a safe and effective technique for the management of spleens larger than 20 cm. The technique results in shorter hospital stays, and it is a good alternative to open splenectomy when treating patients with massive splenomegaly.     

Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies

Background  

Although some studies have compared laparoscopic and hand-assisted laparoscopic splenectomy (HALS) in splenomegaly cases, no study has analyzed the differences between HALS and open splenectomy (OS). This study aimed to compare the HALS and OS techniques in splenomegaly cases.     

手助腹腔镜技术在外伤性脾破裂中的应用

目的:探讨手助腹腔镜技术治疗外伤性脾破裂的临床价值。方法:19例外伤性脾破裂患者用手助腹腔镜技术行脾切除术。结果:18例手术均顺利完成,1例中转开腹,手术时间40～130min,平均60min,术后恢复良好,全组术后均无并发症发生及手术死亡病例。结论:手助腹腔镜技术治疗外伤性脾破裂患者创伤小,术后康复快,并发症少,是一种安全可行的术式。     

Laparoscopic splenectomy for massive splenomegaly using a Lahey bag

BACKGROUND: Although the recent development of hand-assisted laparoscopic surgery (HALS) has made the laparoscopic retraction of large spleens feasible, the laparoscopic removal of massively enlarged spleens (>1,000 g) remains a significant problem because these spleens do not fit into endoscopic bags. Consequently, in order to remove massive spleens either a large abdominal incision or morcellation of the spleen outside of an endoscopy bag is required. METHODS: Two patients, with spleens weighing 2,510 g and 1,720 g, underwent laparoscopic splenectomy using a hand port to ensure safe retraction. The massive spleen was placed into a Lahey bag that was inserted into the abdomen through the hand port site. While in the Lahey bag, the spleen was removed piecemeal through the hand port site. RESULTS: Both operations were completed laparoscopically without complications. The patients were discharged on postoperative day 2 and experienced minimal morbidity. CONCLUSIONS: The Lahey bag facilitates laparoscopic splenectomy for massive splenomegaly as even the most massive spleens will fit into a Lahey bag. A massive spleen may be removed piecemeal from the Lahey bag through the small hand port incision without risking a large abdominal incision, splenosis, or the insertion of a morcellator.