CAJ | 학술논문

目的比较使用腔镜切割闭合器(Endo-GIA)离断脾蒂和二级脾蒂离断法在腹腔镜脾切除术中的临床应用价值.方法回顾性分析60例行腹腔镜下脾切除术患者的临床资料,根据脾蒂离断方法不同分为两组,使用Endo-GIA离断脾蒂30例(A组);二级脾蒂离断法30例(B组).观察比较两组患者手术时间、术中出血量、术后排气时间、术后并发症、引流管带管时间、住院费用及住院时间等指标.结果 60例患者手术均顺利完成,A组手术时间短于B组,差异有统计学意义(P=0.000),但B组术中出血量、术后排气时间、引流管带管时间、住院时间、住院费用均优于A组[(230.90±9.92) ml比(300.10±50.36) ml、(28.5±3.2)h比(31.6±5.3)h、(5±2)d比(7±3)d、(9.68±0.98)d比(12.16±1.34)d、(3.31±0.50)万元比(4.65±0.80)万元],差异有统计学意义(P值均为0.000).两组患者术后发热、腹腔积液、高淀粉酶血症等不良反应发生率比较差异无统计学意义(P＞0.05).结论使用Endo-G1A离断脾蒂和二级脾蒂离断法在腹腔镜脾切除术中都安全可行,但二级脾蒂离断法较使用Endo-GIA离断脾蒂术中出血量少、价格低廉,适合西北贫困地区推广.
목적 비교사용강경절할폐합기(Endo-GIA)리단비체화이급비체리단법재복강경비절제술중적림상응용개치.방법 회고성분석60례행복강경하비절제술환자적림상자료,근거비체리단방법불동분위량조,사용Endo-GIA리단비체30례(A조);이급비체리단법30례(B조).관찰비교량조환자수술시간、술중출혈량、술후배기시간、술후병발증、인류관대관시간、주원비용급주원시간등지표.결과 60례환자수술균순리완성,A조수술시간단우B조,차이유통계학의의(P=0.000),단B조술중출혈량、술후배기시간、인류관대관시간、주원시간、주원비용균우우A조[(230.90±9.92) ml비(300.10±50.36) ml、(28.5±3.2)h비(31.6±5.3)h、(5±2)d비(7±3)d、(9.68±0.98)d비(12.16±1.34)d、(3.31±0.50)만원비(4.65±0.80)만원],차이유통계학의의(P치균위0.000).량조환자술후발열、복강적액、고정분매혈증등불량반응발생솔비교차이무통계학의의(P＞0.05).결론 사용Endo-G1A리단비체화이급비체리단법재복강경비절제술중도안전가행,단이급비체리단법교사용Endo-GIA리단비체술중출혈량소、개격저렴,괄합서북빈곤지구추엄.
Objective To compare the application value of Endo-GIA procedure and secondary splenic pedicle disconnection for laparoscopic splenectomy.Methods The clinical data of 60 patients underwent laparoscopic splenectomy were retrospectively analysed.They were divided into two groups according to the method of splenic pedicle disconnection:group A (30 cases) was given Endo-GIA procedure and group B (30 cases) was given secondary splenic pedicle disconnection.The operation time,perioperative blood loss,postoperative exhaust time,indwelling time of drainage tube,hospitalization expenses and hospitalization time between two groups were observed.Results Sixty patients successfully underwent surgery,operation time in group A was shorter than that in group B (P=0.000),but perioperative blood loss,postoperative exhaust time,indwelling time of drainage tube,hospitalization time and hospitalization expense in group B were better than those in group A[(230.90 ± 9.92) ml vs.(300.10 ± 50.36) ml,(28.5±3.2)hvs.(31.6±5.3)h,(5±2)dvs.(7±3)d,(9.68±0.98)dvs.(12.16±1.34) d,(3.31 ± 0.50) million yuan vs.(4.65 ± 0.80) million yuan] (P =0.000).The incidence of complications such as postoperative fever,peritoneal effusion and hyperamylasemia between two groups had no significant difference (P ＞ 0.05).Conclusion Two methods for laparoscopic splenectomy is safe and feasible,but the secondary splenic pedicle disconnection for laparoscopic splenectomy is lower in perioperative blood loss,hospitalization expenses than Endo-GIA procedure,suitable for poor areas of northwest China.