龔海軍 余春華 魯鋼
[摘要] 目的 以肝硬化致脾功能亢進(jìn)患者為研究對(duì)象,探討患者應(yīng)用腹腔鏡脾臟切除術(shù)的治療效果。 方法 將2018年1月~2019年12月接受手術(shù)治療肝硬化致脾功能亢進(jìn)癥患者32例隨機(jī)分成兩組,對(duì)照組16例患者應(yīng)用開(kāi)腹脾臟切除術(shù)治療,觀察組16例患者應(yīng)用腹腔鏡脾臟切除術(shù)治療,觀察對(duì)比兩組手術(shù)相關(guān)指標(biāo)、手術(shù)前后肝功能指標(biāo)及術(shù)后并發(fā)癥情況。 結(jié)果 觀察組術(shù)中失血量(287.46±36.01)mL、手術(shù)時(shí)間(105.39±15.27)min、拔管時(shí)間(4.71±1.50)d、術(shù)后住院時(shí)間(7.66±2.48)d,對(duì)照組各項(xiàng)指標(biāo)分別為(335.23±35.28)mL、(83.51±14.34)min、(6.23±1.49)d、(10.23±2.60)d,觀察組術(shù)中失血量少于對(duì)照組,手術(shù)時(shí)間長(zhǎng)于對(duì)照組,拔管時(shí)間以及術(shù)后住院時(shí)間均短于對(duì)照組(P<0.05)。術(shù)后觀察組DBIL為(7.23±1.30)μmol/L、AST為(37.28±4.39)μmol/L、ALT為(40.13±3.28)μmol/L,對(duì)照組各項(xiàng)指標(biāo)分別為(9.64±1.35)μmol/L、(51.19±4.47)μmol/L、(47.36±3.31)μmol/L,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組TBIL為(26.02±3.17)μmol/L、對(duì)照組為(25.68±3.19)μmol/L,兩組TBIL水平無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。觀察組無(wú)肺部感染者,胸腔積液率為6.25%、切口感染率為6.25%、腹腔積液率為12.50%。觀察組肺部感染、胸腔積液及切口感染發(fā)生率均較對(duì)照組低(P<0.05),兩組腹腔積液發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。 結(jié)論 腹腔鏡脾臟切除術(shù)在肝硬化致脾功能亢進(jìn)治療中的應(yīng)用價(jià)值較高,能夠取得確切療效且治療安全性較高,可顯著改善患者肝功能。
[關(guān)鍵詞] 腹腔鏡脾臟切除術(shù);肝硬化;脾功能亢進(jìn);肝功能;手術(shù)指標(biāo);術(shù)后并發(fā)癥
[中圖分類號(hào)] R657.6 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] B ? ? ? ? ?[文章編號(hào)] 1673-9701(2020)24-0046-03
[Abstract] Objective To explore the therapeutic effect of laparoscopic splenectomy(LS) on the patients with hypersplenism caused by hepatocirrhosis. Methods 32 patients with hypersplenism caused by hepatocirrhosis who received surgical treatment from January 2018 to December 2019 were randomly divided into two groups. The 16 patients of the control group were treated with open splenectomy, while the 16 patients of the observation group were treated with LS. The operation-related indexes, liver function indexes before and after operation and postoperative complications of the two groups were observed and compared. Results In the observation group, the intraoperative blood loss was(287.46±36.01) mL, the operation time was(105.39±15.27) min., the extubation time was(4.71±1.50) d, the postoperative hospitalization time was(7.66±2.48) d, while in the control group, the corresponding indexes were(335.23±35.28) mL, (83.51±14.34) min, (6.23±1.49) d, and(10.23±2.60) d respectively. The blood loss in the observation group was less than that in the control group, the operation time was longer than that in the control group, and the extubation time and the postoperative hospitalization time were both shorter than those in the control group(P<0.05). The DBIL of the observation group after operation was(7.23±1.30) μmol/L, the AST was(37.28±4.39) μmol/L, and the ALT was(40.13±3.28) μmol/L, while these indexes of the control group were(9.64±1.35) μmol/L, (51.19±4.47) μmol/L, and(47.36±3.31) μmol/L respectively, the difference was statistically significant(P<0.05). The TBIL of the observation group was(26.02±3.17) μmol/L, while that of the control group was(25.68±3.19) μmol/L, with no statistically significant difference in TBIL level between the two groups(P>0.05). There was no pulmonary infection in the patients of the observation group, the incidence of pleural effusion was 6.25%, the incidence of incision infection was 6.25%, and the incidence of peritoneal effusion was 12.50%. The incidence of pulmonary infection, pleural effusion and incision infection in the observation group was lower than that in the control group(P<0.05), and there was no statistically significant difference in the incidence of peritoneal effusion between the two groups(P>0.05). Conclusion LS has great application value in the treatment of hypersplenism caused by hepatocirrhosis. It produces definite therapeutic effect and has sound safety in treatment, which can significantly improve the patients liver functions.
綜上所述,肝硬化患者肝功能儲(chǔ)備較差,開(kāi)腹手術(shù)及腹腔鏡脾臟切除術(shù)均有助于促進(jìn)其肝功能改善,但是與開(kāi)腹手術(shù)相比,腹腔鏡脾臟切除術(shù)在肝硬化致脾功能亢進(jìn)治療中療效更加確切,創(chuàng)傷小、術(shù)后并發(fā)癥少、恢復(fù)快,值得臨床應(yīng)用。
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(收稿日期:2020-05-15)