【摘要】 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(P<0.05)。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(P<0.05)。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。更多还原

【Abstract】 Objective To explore the clinical curative effectiveness of laparoscopic splenectomy in the treatment of megalosplenia and its effect on the stress response in patients.Methods Thirty-eight patients with megalosplenia in our hospital from January 2013 to June 2016 served as the clinical research subjects.Nineteen patients underwent laparoscopic splenectomy(LS),and the rest underwent open splenectomy(OS).Intraoperative blood loss,incision length,operative time,intestinal function recovery time,hospital stay and postoperative complications were recorded.The stress-related indexes(CRP,PCT,IL-6,TNF-alpha) were determined one day before and 1 day and 7 days after operation,and analyzed statistically.Results Except the operative time,there was significant difference in incision length,intraoperative bleeding,hospital stay,intestinal function recovery time,and postoperative complication rate between LS group and OS group(P<0.05).CRP,PTC,IL-6 and TNF-α levels were significantly increased on the postoperative day(POD) 1 in both two groups,and those were significantly decreased on the POD 7.CRP,PTC,IL-6 and TNF-α levels in LS group were significantly reduced as compared with those in OS group on the POD 1 and 7(P<0.05).Conclusions In the clinical treatment of patients with megalosplenia,LS has less invasive,quicker postoperative recovery,less impact on the stress response of patients,and lower complication rate.更多还原