应用腹腔镜治疗急性创伤性脾破裂临床研究

【目的】初步探讨腹腔镜在治疗创伤性脾破裂的优势及应用价值。【方法】选定我院2011年3月-2013年3月间急性创伤性脾破裂病例。根据术前超声多普勒及cT共同评估腹腔游离液体不大于300ml，且血流动力学稳定收缩压〉90mmHg（1mmHg=0．1333kPa）]的9例作为腹腔镜组，并选择同期开腹手术17例作为开腹组。采用成组资料f检验（或f检验）或卡方检验比较手术时间、住院天数、首次排气时间及切口感染率等。【结果】腹腔镜组患者无1例中转开腹及死亡。腹腔镜治疗后患者首次排气时间（2．65±0．22）d较开腹手术组（3．63±0．37）d缩短（P〈0．01）；腹腔镜治疗后患者术后切口生长良好，较开腹手术组（47．05％，8／17）低（P〈0．05），腹腔镜组手术时间（141．67±6．61）min要长于开腹组（78．52±8．43）min，有显著差别（P〈0．01）。而腹腔镜组住院时间（6．22±0．67）d明显短于开腹组（9．23±1．82）d（e〈0．01）。【结论】正确评估损伤的前提下，采用腹腔镜治疗急性创伤性脾破裂是一种副作用较小的可行方法。

Clinical study on laparoscopic treatment of acute traumatic splenic rupture

Objective] To explore the application of laparoscopic technology in treating acute traumatic blunt spleen rupture. Methods] Patients suffered from traumatic blunt spleen rupture were selected. Abdominal CT and color Doppler were used for diagnosis and the operation indication criteria included the splenic uneven density of CT, visible free liquid with volume no more than 300 ml in the abdominal cavity. 9 patients were treated using laparoseopic treatment which met the indication criteria and 17 patients were treated with the ordinary operations by the incision of the abdomen. Data were analyzed using independent sample t test or chi square test between two groups. Results ] There were no death and no conversion to laparotomy. The first fart time in the laparoseopic treatment group （2.65 ± 0.22） d was shorter than that of the control group （3.63 ± 0.37） d （P 〈 0.01）. No infection caused by the operation in the laparoscopic treatment group were observed, however, in the control group, nearly half of the patients（47.05%, 8/17） had infections after the operation （P 〈 0.05）. Also, shorter of the hospitalization time were observed in the laparoscopy （6.22 ± 0.67） d when compared with the control group （9.23 ± 1.82） d （P 〈 0.01）. Longer of operation time in the laparoscopy group （141.67 ± 6.61） min than that of the control group （78.52 ± 8.43） rain were observed （ P 〈 0.01）. Conclusion] Based upon the right diagnosis, the laparoscopy maybe, a feasible method in treating the traumatic blunt spleen rupture with less side effects..