中华实验外科杂志
中華實驗外科雜誌
중화실험외과잡지
CHINESE JOURNAL OF EXPERIMENTAL SURGERY
2013年
12期
2701-2703
,共3页
邓小荣%彭七华%赵艳平%姜进平%林云%罗翠松
鄧小榮%彭七華%趙豔平%薑進平%林雲%囉翠鬆
산소영%팽칠화%조염평%강진평%림운%라취송
腹腔镜,手助%巨脾症%脾血回输
腹腔鏡,手助%巨脾癥%脾血迴輸
복강경,수조%거비증%비혈회수
Hand-assisted laparoscopic splenectomy%Splenomegaly%Splenic blood transfusion
目的 探讨免辅助装置手助腹腔镜巨脾切除的可行性、技术优势以及术中同步脾血回输的临床价值.方法 分析自2007年10月至2011年10月间行巨脾切除的肝硬化门脉高压症48例患者的临床资料,按手术方式分免辅助装置的手助腹腔镜组(n=30)、完全腹腔镜组(n=12),另6例为中转手助或开腹手术.比较术中出血、手术时间与取脾时间;按脾脏长径(＞ 20 em或≤20 cm)分为重度脾肿大(n=28)与中度脾肿大(n=20),比较两者的术中出血及中转手术率.采用血液回输机进行同步脾血回输.结果 免辅助装置不影响手术中气腹的保持,平均每例患者节省费用约2000元.手助腹腔镜组与完全腹腔镜组的平均出血量差异无统计学意义[(88.1±16.3) ml比(107.5±11.6)ml,P＞0.05];手助腹腔镜组平均手术时间明显短于完全腹腔镜组[(75.2±13.3) min比(120.7±20.5)min,P＜0.05];手助腹腔镜组平均取脾时间明显短于完全腹腔镜组[(8.0±3.1) min比(25.2±2.8)min,P＜0.05).重度脾肿大患者的手术中转率(50％)显著高于中度脾肿大患者(20％,P＜0.01);术中出血明显高于中度脾肿大患者[(103.8±25.0) ml比(70.4±10.3) ml,P＜0.01].术后第1天,同步睥血回输的患者血红蛋白较术前显著升高[(2.07±0.25) g/L,P＜0.05].结论 手助腹腔镜巨脾切除术具有较强的安全性与可行性,尤其对于重度脾肿大患者显示明显优势;免辅助装置有效而经济;同步脾血回输明显提高患者血红蛋白水平.
目的 探討免輔助裝置手助腹腔鏡巨脾切除的可行性、技術優勢以及術中同步脾血迴輸的臨床價值.方法 分析自2007年10月至2011年10月間行巨脾切除的肝硬化門脈高壓癥48例患者的臨床資料,按手術方式分免輔助裝置的手助腹腔鏡組(n=30)、完全腹腔鏡組(n=12),另6例為中轉手助或開腹手術.比較術中齣血、手術時間與取脾時間;按脾髒長徑(＞ 20 em或≤20 cm)分為重度脾腫大(n=28)與中度脾腫大(n=20),比較兩者的術中齣血及中轉手術率.採用血液迴輸機進行同步脾血迴輸.結果 免輔助裝置不影響手術中氣腹的保持,平均每例患者節省費用約2000元.手助腹腔鏡組與完全腹腔鏡組的平均齣血量差異無統計學意義[(88.1±16.3) ml比(107.5±11.6)ml,P＞0.05];手助腹腔鏡組平均手術時間明顯短于完全腹腔鏡組[(75.2±13.3) min比(120.7±20.5)min,P＜0.05];手助腹腔鏡組平均取脾時間明顯短于完全腹腔鏡組[(8.0±3.1) min比(25.2±2.8)min,P＜0.05).重度脾腫大患者的手術中轉率(50％)顯著高于中度脾腫大患者(20％,P＜0.01);術中齣血明顯高于中度脾腫大患者[(103.8±25.0) ml比(70.4±10.3) ml,P＜0.01].術後第1天,同步睥血迴輸的患者血紅蛋白較術前顯著升高[(2.07±0.25) g/L,P＜0.05].結論 手助腹腔鏡巨脾切除術具有較彊的安全性與可行性,尤其對于重度脾腫大患者顯示明顯優勢;免輔助裝置有效而經濟;同步脾血迴輸明顯提高患者血紅蛋白水平.
목적 탐토면보조장치수조복강경거비절제적가행성、기술우세이급술중동보비혈회수적림상개치.방법 분석자2007년10월지2011년10월간행거비절제적간경화문맥고압증48례환자적림상자료,안수술방식분면보조장치적수조복강경조(n=30)、완전복강경조(n=12),령6례위중전수조혹개복수술.비교술중출혈、수술시간여취비시간;안비장장경(＞ 20 em혹≤20 cm)분위중도비종대(n=28)여중도비종대(n=20),비교량자적술중출혈급중전수술솔.채용혈액회수궤진행동보비혈회수.결과 면보조장치불영향수술중기복적보지,평균매례환자절성비용약2000원.수조복강경조여완전복강경조적평균출혈량차이무통계학의의[(88.1±16.3) ml비(107.5±11.6)ml,P＞0.05];수조복강경조평균수술시간명현단우완전복강경조[(75.2±13.3) min비(120.7±20.5)min,P＜0.05];수조복강경조평균취비시간명현단우완전복강경조[(8.0±3.1) min비(25.2±2.8)min,P＜0.05).중도비종대환자적수술중전솔(50％)현저고우중도비종대환자(20％,P＜0.01);술중출혈명현고우중도비종대환자[(103.8±25.0) ml비(70.4±10.3) ml,P＜0.01].술후제1천,동보비혈회수적환자혈홍단백교술전현저승고[(2.07±0.25) g/L,P＜0.05].결론 수조복강경거비절제술구유교강적안전성여가행성,우기대우중도비종대환자현시명현우세;면보조장치유효이경제;동보비혈회수명현제고환자혈홍단백수평.
Objective To investigate the feasibility and advantage of hand assisted laparoscopic splenectomy for giant spleens without auxiliary device and the clinical value of intraoperative autologous splenic blood transfusion.Methods From October 2007 to October 2011,48 cases of liver cirrhosis splenomegaly were analyzed retrospectively according to operation method including hand assisted laparoscopic splenectomy group with free auxiliary device (HALS) (n =30) and conventional laparoscopic splenectomy (CLS) (n =12),and they were divided into two groups:severe splenomegaly group (the length of the spleen more than 20 cm) and moderate splenomegaly (the length of the spleen less than 20 cm).The intraoperative bleeding,operation time,the spleen removal time and transit operation rate were compared in these patients.The blood transfusion machine was used for autologous splenic blood transfusion.Results Free auxiliary device saved at least 2000 yuan without affecting the maintenance of pneumoperitoneum during operation.There was no significant difference in the average blood loss between HALS group and CLS group [(88.1 ± 16.3) ml vs.(107.5 ± 11.6) ml,P ＞0.05].The average operation time was significantly shorter [(75.2 ± 13.3) min vs.(120.7 ± 20.5) min,P ＜ 0.05],and the spleen removal time was markedly shorter [(8.0 ±3.1) min vs.(25.2 ±2.8) min,P ＜0.05] in HALS group than in CLS group.The transit operation rate of severe splenomegaly (50％) was significantly higher than moderate splenomegaly (20％) (P ＜ 0.01),and the intraoperative bleeding too [(103.8 ± 25.0) ml vs.(70.4 ± 10.3) ml,P ＜0.01].Intraoperative autologous splenic blood transfusion significantly elevatedf hemoglobin level on the first day after operation [(2.07 ± 0.25) g/L,P ＜ 0.05].Conclusion HALS significantly facilitates the surgical procedure and reduces the operational risk,while maintaining the advantages of CLS.Hand-assisted laparoscopic splenectomy is a safe and effective technique especially for the management of severe splenomegaly.Intraoperative autologous splenic blood transfusion shows obvious special advantage in ascending hemoglobin.
