两种方法在腹腔镜脾切除术中的比较研究

目的比较使用腔镜切割闭合器（Endo—GIA）离断脾蒂和二级脾蒂离断法在腹腔镜脾切除术中的临床应用价值。方法回顾性分析60例行腹腔镜下脾切除术患者的临床资料,根据脾蒂离断方法不同分为两组,使用Endo-GIA离断脾蒂30例（A组）;二级脾蒂离断法30例（B组）。观察比较两组患者手术时间、术中出血量、术后排气时间、术后并发症、引流管带管时间、住院费用及住院时间等指标。结果60例患者手术均顺利完成,A组手术时间短于B组,差异有统计学意义（P=0．000）,但B组术中出血量、术后排气时间、引流管带管时间、住院时间、住院费用均优于A组l（230,90±9．92）ml比（300．10±50．36）ml、（28．5±3．2）h比（31．6±5．3）h、（5±2）d比（7±3）d、（9．68±0．98）d比（12．16±1．34）d、（3．31±0．50）万元比（4．65±0．80）万元],差异有统计学意义（P值均为0．000）。两组患者术后发热、腹腔积液、高淀粉酶血症等不良反应发生率比较差异无统计学意义（P〉0．05）。结论使用Endo—GIA离断脾蒂和二级脾蒂离断法在腹腔镜脾切除术中都安全可行,但二级脾蒂离断法较使用Endo—GIA离断脾蒂术中出血量少、价格低廉,适合西北贫困地区推广。     

Predictive Value of Inflammation Biomarkers in Patients with Portal Vein Thrombosis

Background and AimsTo investigate the usefulness of inflammation biomarkers to serve as a predictors of portal vein thrombosis (PVT) postoperatively (post) in patients with portal hypertension after splenectomy and periesophagogastric devascularization.MethodsA total of 177 liver cirrhosis patients were recruited from January 2013 to December 2017. They were divided into a PVT group (n=71) and a non-PVT group (n=106), according to ultrasound examination findings at 7-day post. Inflammation biomarkers involving platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), red blood cell distribution width-to-platelet ratio(RPR), mean platelet volume-to-platelet ratio (MPR) preoperatively (pre) and at 1, 3, 7-days post were recorded.ResultsThe univariate logistic regression analysis indicated that PLR (pre) (odds ratio (OR)=3.963, 95% confidence interval (CI)=2.070–7.587, p<0.000), MLR (pre) (OR=2.760, 95% CI=1.386–5.497, p=0.004), PLR (post-day 7) (OR=3.345, 95% CI=1.767–6.332, p=0.000) were significantly associated with the presence of PVT. The multivariate logistic regression analysis results indicated that PLR (pre) (OR=3.037, 95% CI=1.463–6.305, p=0.003), MLR (pre) (OR=2.188, 95% CI=1.003–4.772, p=0.049), PLR(post-day 7) (OR=2.166, 95% CI=1.053–4.454, p=0.036) were independent factors for predicting PVT.ConclusionsThe PLR (pre), MLR (pre), and PLR (post-day 7) are predictors of portal vein thrombosis post in patients with portal hypertension after splenectomy and periesophagogastric devascularization.     

多种腹腔镜脾切除术七例报道

目的探讨多种腹腔镜脾切除术(LS)术式的设计、实施及其适应证。方法对7例不同疾病的病例设计并实施了LS、手助腹腔镜脾切除加门奇静脉断流术(HLSPD)、非气腹装置辅助的LS(GDLS)、手助LS(HLS)与改良HLS(MHLS)。结果手术时间为60～240min,术中出血量约为50～1500ml。病人术后均恢复顺利。结论LS适合于无肿大的脾脏切除;HLSPD适合于门静脉高压症合并巨脾者,特别是尚伴有卵巢囊肿、胆囊结石等其它病变需同时处理者;GDLS、HLS与MHLS适合于脾脏中度增大者。其中,GDLS和MHLS尤其适合于经济条件有限的病人。     

Predictors of postoperative pancreatic fistula after splenectomy with or without distal pancreatectomy performed as a component of cytoreductive surgery for advanced ovarian cancer

ObjectiveSplenectomy with or without distal pancreatectomy is occasionally performed during cytoreductive surgery for advanced ovarian cancer. We investigated pre-, intra-, postoperative risk factors and predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) in patients who underwent cytoreductive surgery for advanced ovarian cancer.MethodsWe investigated 165 consecutive patients with ovarian, fallopian tube, and peritoneal carcinoma categorized as stage III/IV disease, who underwent splenectomy with or without distal pancreatectomy as a component of cytoreductive surgery performed as initial treatment at Chiba University Hospital. Patient characteristics, clinical factors, and surgical outcomes were compared between those with and without CR-POPF.ResultsCR-POPF occurred in 20 patients (12%). There were no significant intergroup differences in the characteristics between patients with CR-POPF and patients without CR-POPF except for operative time, intraoperative blood loss, amylase (AMY) levels in drain fluid on postoperative day (POD)1 and POD3, and pancreatic stump thickness. Multivariate analysis showed that the POD3 drain fluid AMY level was the only significant risk factor and predictor of CR-POPF in patients who underwent cytoreductive surgery for advanced ovarian cancer. The receiver operating characteristic curve of the POD3 drain fluid AMY level, which predicted development of CR-POPF showed an area under the curve of 0.77, and the optimal cut-off value of AMY was 808 U/L. A pancreatic fistula did not occur in patients with POD3 drain fluid AMY levels <130 U/L.ConclusionThe POD3 drain fluid AMY level can be early diagnostic predictor CR-POPF after splenectomy with or without distal pancreatectomy for advanced ovarian cancer.     

腹腔镜脾切除治疗肝硬化脾功能亢进(附6例报告)

目的探讨腹腔镜脾切除治疗脾功能亢进的技巧和方法。方法用二级脾蒂血管离断法对6例肝硬化脾功能亢进的病人行腹腔镜脾切除。结果所有病例均在腔镜下完成,无中转开腹。手术时间210～310min(平均250min),术中失血250～650ml(平均350ml),术后平均住院7.5d,无术后并发症。结论腹腔镜脾切除治疗肝硬化脾功能亢进的病人行是安全、可行、微创的方法。     

腹腔镜巨脾切除术10例

目的探讨腹腔镜巨脾切除术的临床可行性。方法回顾分析作者医院2006年1月~2006年12月10例(其中手助7例)腹腔镜巨脾切除术的临床资料。结果10例腹腔镜下巨脾切除术全部成功,手术时间60~170 min,平均90 min;术中出血100~900 ml,平均350 ml;术后住院5~12 d,平均8.5 d,无术后明显并发症。术后引流留置3~8 d,平均5 d。结论腹腔镜巨脾切除术在临床上是安全可行的。     

脾切除术加贲门周围血管离断术治疗门静脉高压症的疗效分析

目的探讨脾切除加贲门周围血管离断术治疗门静脉高压症的疗效。方法回顾68例采用脾切除加贲门周围血管离断术治疗门静脉高压症的临床资料,对手术前后肝功能、再出血率、并发症发生率等进行分析。结果无手术死亡术后半个月肝功能好转58例,无变化10例。术后随访6个月~4年,再出血率9%,全组病人脾亢症状消失。结论脾切除加贲门周围血管离断术治疗门静脉高压症疗效确切,操作简便,止血可靠,再出血率低,有良好的临床实用价值。     

改良脾脏后外侧入路在腹腔镜巨脾切除术中的应用评价

目的:探讨改良脾脏后外侧入路在腹腔镜巨脾切除术中的临床应用价值。方法:回顾性分析2016年1月至2019年7月在江南大学附属医院接受腹腔镜脾切除术(LS)的巨脾患者临床资料。共入组48例患者,其中男性29例,女性19例,平均年龄55.8岁。根据手术分离脾脏入路分为研究组( n＝26)：采用改良脾脏后外侧入路...     

脾切除术治疗特发性血小板减少性紫癜75例预后分析

目的 探讨脾切除术治疗特发性血小板减少性紫癜（ITP）的疗效及术前临床指标对疗效的影响。 方法 回顾75例（男11例,女64例）脾切除ITP患者的临床资料,按照性别、年龄、病程、血小板计数、骨髓巨核细胞数目、脾脏大小、激素治疗效果进行分组,比较分析各项因素与脾切除疗效之间的关系。结果 75例中显效42例(56.0%),良效18例(24.0%),进步9例(12.0%),无效6例(8%),8例术后复发。有效率（显效+良效占总病例数的百分比）为80.0%;男、女患者有效率分别为81.8％（9/11）、79.7％（51/64）,（P＞0.05）;脾脏肿大、无肿大患者有效率分别为80.3％、77.8％（P＞0.05）;40岁以下、40岁以上患者有效率分别为85.4％、70.4％ (P＜0.05);糖皮质激素治疗有效、治疗无效患者的脾切除有效率分别为85.2％、66.7％ (P＜0.05);骨髓巨核细胞密度≥（7～35）个/(3cm×1.5cm) 、＜ （7～35）个/(3cm×1.5cm)患者有效率分别为85.7％、63.2％(P＜0.05); 术前血小板计数＞20×109个/L、＜20×109个/L患者有效率分别为86.0％、68.0％(P＜0.05);病程6个月以下、6个月以上患者有效率分别为84.5％、64.7％(P＜0.05)。结论 性别、脾脏是否肿大与脾切除术的疗效预测无关;年龄、病程、骨髓巨核细胞数、血小板计数、对糖皮质激素的治疗反应与脾切除术疗效的预测有明显相关性。