全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2014年
3期
253-255
,共3页
赵红欣%周鸿鲲%张浩%徐鹿平%谢琦
趙紅訢%週鴻鯤%張浩%徐鹿平%謝琦
조홍흔%주홍곤%장호%서록평%사기
腹腔镜%脾切除术%血吸虫性肝硬化%脾功能亢进
腹腔鏡%脾切除術%血吸蟲性肝硬化%脾功能亢進
복강경%비절제술%혈흡충성간경화%비공능항진
laparoscopy%splenectomy%schistosomal cirrhosis%hypersplenism
目的：探讨腹腔镜脾切除术治疗血吸虫性肝硬化引起的脾功能亢进的临床应用价值。方法对50例血吸虫性肝硬化脾亢患者行脾切除术，其中腹腔镜组（A组）31例行完全腹腔镜手术，开腹组（B组）19例行传统开腹手术。比较两组患者的手术时间、术中出血量、术后住院时间、术后1 d切口疼痛评分、术后3 d超敏C反应蛋白（hs-CRP）及引流液淀粉酶（Amy）、术后7 d血小板计数（Plt）、白细胞计数（WBC）。结果 A组成功完成腹腔镜手术29例，中转开腹2例。 A组手术时间较B组长，术后1 d切口疼痛评分、术后住院时间及术后3d hs-CRP、Amy指标A组均小于B组，差异具有统计学意义（t分别=3.21、5.10、7.16、3.00、1.74，P均＜0.05），而两组术中出血量、术后7 d Plt、WBC差异均无统计学意义（t分别=1.47、1.02、0.67，P均＞0.05）。结论采用腹腔镜脾切除术治疗血吸虫性肝硬化患者脾功能亢进是安全有效的。相对传统开腹手术而言，具有创伤小、恢复快，住院时间缩短，并发症少，术后疼痛轻等优点。
目的：探討腹腔鏡脾切除術治療血吸蟲性肝硬化引起的脾功能亢進的臨床應用價值。方法對50例血吸蟲性肝硬化脾亢患者行脾切除術，其中腹腔鏡組（A組）31例行完全腹腔鏡手術，開腹組（B組）19例行傳統開腹手術。比較兩組患者的手術時間、術中齣血量、術後住院時間、術後1 d切口疼痛評分、術後3 d超敏C反應蛋白（hs-CRP）及引流液澱粉酶（Amy）、術後7 d血小闆計數（Plt）、白細胞計數（WBC）。結果 A組成功完成腹腔鏡手術29例，中轉開腹2例。 A組手術時間較B組長，術後1 d切口疼痛評分、術後住院時間及術後3d hs-CRP、Amy指標A組均小于B組，差異具有統計學意義（t分彆=3.21、5.10、7.16、3.00、1.74，P均＜0.05），而兩組術中齣血量、術後7 d Plt、WBC差異均無統計學意義（t分彆=1.47、1.02、0.67，P均＞0.05）。結論採用腹腔鏡脾切除術治療血吸蟲性肝硬化患者脾功能亢進是安全有效的。相對傳統開腹手術而言，具有創傷小、恢複快，住院時間縮短，併髮癥少，術後疼痛輕等優點。
목적：탐토복강경비절제술치료혈흡충성간경화인기적비공능항진적림상응용개치。방법대50례혈흡충성간경화비항환자행비절제술，기중복강경조（A조）31례행완전복강경수술，개복조（B조）19례행전통개복수술。비교량조환자적수술시간、술중출혈량、술후주원시간、술후1 d절구동통평분、술후3 d초민C반응단백（hs-CRP）급인류액정분매（Amy）、술후7 d혈소판계수（Plt）、백세포계수（WBC）。결과 A조성공완성복강경수술29례，중전개복2례。 A조수술시간교B조장，술후1 d절구동통평분、술후주원시간급술후3d hs-CRP、Amy지표A조균소우B조，차이구유통계학의의（t분별=3.21、5.10、7.16、3.00、1.74，P균＜0.05），이량조술중출혈량、술후7 d Plt、WBC차이균무통계학의의（t분별=1.47、1.02、0.67，P균＞0.05）。결론채용복강경비절제술치료혈흡충성간경화환자비공능항진시안전유효적。상대전통개복수술이언，구유창상소、회복쾌，주원시간축단，병발증소，술후동통경등우점。
Objective To investigate the value of laparoscopic splenectomy (LS) for hypersplenism caused by schistosomal cirrhosis. Methods Fifty hypersplenism patients divided to two groups, the patients of group LS (group A) accepted laparoscopic splenectomy,and the patients of group OS (group B) accepted open splenectomy (OS). The terms such as operation duration, the estimated blood loss, postoperative hospital stay, the score of incision pain on 1 day after operation, hs-CRP and amylase level on 3 days after operation, Platelet count and WBC level on 7 days after operation were compared between the groups. Results Twenty nine cases of group A were completed under laparoscopy and 2 cases were converted to open surgery. Operation duration of group A was longer than that of the group B; the score of incision pain on 1 day after operation,hs-CRP and amylase level on 3 days after operation were better than those of the group B(t=3.21,5.10,7.16,3.00,1.74,P<0.05);there were no differences in the estimated blood loss, Platelet count and WBC level on 7 days after operation between two groups (t=1.47,1.02,0.67,P>0.05). Conclusion It is safe and effective of LS to treat hypersplenism caused by schistosomal cirrhosis. It has advantages of fewer traumas and postoperative pain, quicker recovery, shorter hospital stay and fewer complications.
