【作者】 张建伟；

【导师】 杜晓宏；

【作者基本信息】 吉林大学 ， 临床医学硕士（外科学）（专业学位）， 2019， 硕士

【摘要】 目的:通过比较分析外伤性脾破裂急诊行腹腔镜脾切除术与开腹脾切除术患者的临床资料,探讨急诊腹腔镜脾切除术治疗外伤性脾破裂的适应证及临床疗效。方法:回顾性分析吉林大学第一医院肝胆胰外一科2013年12月-2018年12月采用手术治疗外伤性脾破裂的63例病人的临床资料,按手术方式进行分组(急诊LS组32例;急诊OS组31例),比较急诊LS组与急诊OS组在年龄、外伤原因、手术距受伤时间、BMI、术前血红蛋白、性别、心率、收缩压、舒张压、损伤等级(我们决定采用美国的AAST分级,因其更容易量化脾脏损伤的程度,而且有对应的ICD编码,便于数据统计)等一般临床资料;手术资料(手术时间、总出血量、术中输血情况、术中自体血使用情况等),术后相关数据(包括住院费用、胃肠道功能恢复时间、腹腔引流管拔出时间、术后住院时间、腹腔引流量及引流液淀粉酶、术后使用镇痛药次数等)及术后发生并发症的相关资料等。资料间的比较采用t检验、卡方检验等,用软件SPSS23.0进行数据处理。结果:急诊LS组与急诊OS组的一般资料比较无统计学意义(P>0.05);手术资料方面,急诊LS组与急诊OS组在手术时间及术中自体血使用情况的比较差异有统计学意义(P<0.05),急诊OS组的手术时间短于急诊LS组,急诊LS组术中使用自体血回输多于急诊OS组;术后相关资料方面,急诊LS组在术后住院时间及胃肠道功能恢复时间方面均短于急诊OS组,有一定的优势,两组比较差异有统计学意义;在术后并发症方面,急诊LS组与急诊OS的比较差异无统计学意义(P>0.05)。结论:急诊LS治疗外伤性脾破裂具有一定的优势,并且是安全可行的:(1)急诊LS治疗外伤性脾破裂时,可清晰观察脾脏的损伤程度,同时腹腔镜具有放大效应,便于处理较细的血管。(2)急诊LS治疗外伤性脾破裂符合损伤控制理论,快速康复理念,具有术后患者疼痛轻、进食早、住院时间短等优势(3)在严格掌握手术适应证的前提下,对于经验丰富的腹腔镜团队来说是安全可行的,急诊腹腔镜脾切除术治疗外伤性脾破裂前景广阔,值得临床推广。更多还原

【Abstract】 Objective:By compared and analyzed the clinical data of emergency laparoscopic splenectomy and open splenectomy for the treatment of traumatic splenic rupture,to discuss the indications and clinical efficacy of emergency laparoscopic splenectomy in the treatment of traumatic splenic rupture,which provided the basis for the selection of surgical scheme.Method:The clinical data of 63 patients with traumatic splenic rupture treated surgically from December 2013 to December 2018 were retrospectively analyzed,in the First Hospital of Jilin University They were divided into two groups(emergency laparoscopic group 32 cases and emergency open group 31 cases).The preoperative general data(including age,sex,heart rate,systolic pressure,diastolic pressure,traumatic causes,the time from operation to injury,and time of operation,BMI,preoperative hemoglobin,injury grade)were compared between the two groups.Intraoperative related data(operation time,total bleeding volume,whether blood transfusion,intraoperative use of autologous blood).Postoperative clinical data(including hospitalization costs,post-operative hospitalization time,abdominal drainage volume on the first day after operation,drainage fluid amylase on the second day after operation,recovery time of gastrointestinal function,extraction time of abdominal drainage tube,post-operative clinical data,the frequency of using analgesics).And the occurrence of common complications after operation.The data were compared using t test,chi-square test,etc.,and processed with software SPSS23.0.Results:There was no significant difference in preoperative general date between the emergency LS group and the emergency open group(P>0.05).In terms of surgical data,there was a statistically significant difference in the operation time and the use of autologous blood between the emergency LS group and the emergency OS group.(P<0.05);postoperative related data,the difference between the emergency LS group and the emergency OS group in the postoperative hospital stay days and gastrointestinal function recovery time were statistically significant;in the postoperative complications,there was no significant difference between the emergency LS group and the emergency OS(P>0.05).Conclusion:Emergency LS has obvious advantages for the treatment of traumatic spleen rupture and emergency LS is safe and feasible:(1)When the emergency LS treats traumatic spleen rupture,the degree of spleen damage can be clearly observed,and the laparoscope has a magnifying effect,which is convenient for treating fine blood vessels.(2)Emergency LS treatment of traumatic spleen rupture is in line with the theory of injury control,rapid recovery concept,with postoperative pain,early eating,short hospital time,etc.(3)Under the premise of strict control of surgical indications,it is safe and feasible for the experienced laparoscopic team.Emergency laparoscopic splenectomy for the treatment of traumatic spleen rupture has broad prospects and is worthy of clinical promotion.更多还原