临床普外科电子杂志
臨床普外科電子雜誌
림상보외과전자잡지
Journal of General Surgery for Clinicians(Electronic Version)
2015年
2期
43-45
,共3页
脾动脉部分栓塞%脾功能亢进%脾切除术
脾動脈部分栓塞%脾功能亢進%脾切除術
비동맥부분전새%비공능항진%비절제술
Partial spleenic embolization%Hypersplenism%Splenectomy
目的 探究采用脾切除术治疗脾动脉部分栓塞后脾功能亢进复发的临床疗效.方法 选取本院于2004年8月至2014年8月收治的脾动脉部分栓塞后脾功能亢进复发患者28例,全部患者采用脾切除术加贲门周围血管离断术的治疗方法,观察患者治疗后的临床疗效.结果 所有患者手术均获得成功,术中见脾脏与周围结肠、胃、膈肌等组织有明显粘连,手术时间为(165.73±48.79) min,术中分离时出现胃损伤2例,膈肌损伤1例;患者术中出血量为(1100±200)ml,术后出血量为(840.25±209.86)ml;切除脾脏重量为(375.81±108.37)g,术后出现反应性胸腔积液14例、胰瘘1例.与治疗前相比,患者的谷丙转氨酶、谷草转氨酶均有下降,但下降程度不明显(P>0.05),无统计学意义;术后1周患者血小板和白细胞计数与治疗前相比有很大程度提高(P<0.05),差异有统计学意义.结论 脾切除术治疗脾动脉部分栓塞后脾功能亢进复发效果良好,术中需仔细分离,小心周围器官的副损伤;术后能够有效消除脾功能亢进症状,对肝功能损伤小,值得临床推广.
目的 探究採用脾切除術治療脾動脈部分栓塞後脾功能亢進複髮的臨床療效.方法 選取本院于2004年8月至2014年8月收治的脾動脈部分栓塞後脾功能亢進複髮患者28例,全部患者採用脾切除術加賁門週圍血管離斷術的治療方法,觀察患者治療後的臨床療效.結果 所有患者手術均穫得成功,術中見脾髒與週圍結腸、胃、膈肌等組織有明顯粘連,手術時間為(165.73±48.79) min,術中分離時齣現胃損傷2例,膈肌損傷1例;患者術中齣血量為(1100±200)ml,術後齣血量為(840.25±209.86)ml;切除脾髒重量為(375.81±108.37)g,術後齣現反應性胸腔積液14例、胰瘺1例.與治療前相比,患者的穀丙轉氨酶、穀草轉氨酶均有下降,但下降程度不明顯(P>0.05),無統計學意義;術後1週患者血小闆和白細胞計數與治療前相比有很大程度提高(P<0.05),差異有統計學意義.結論 脾切除術治療脾動脈部分栓塞後脾功能亢進複髮效果良好,術中需仔細分離,小心週圍器官的副損傷;術後能夠有效消除脾功能亢進癥狀,對肝功能損傷小,值得臨床推廣.
목적 탐구채용비절제술치료비동맥부분전새후비공능항진복발적림상료효.방법 선취본원우2004년8월지2014년8월수치적비동맥부분전새후비공능항진복발환자28례,전부환자채용비절제술가분문주위혈관리단술적치료방법,관찰환자치료후적림상료효.결과 소유환자수술균획득성공,술중견비장여주위결장、위、격기등조직유명현점련,수술시간위(165.73±48.79) min,술중분리시출현위손상2례,격기손상1례;환자술중출혈량위(1100±200)ml,술후출혈량위(840.25±209.86)ml;절제비장중량위(375.81±108.37)g,술후출현반응성흉강적액14례、이루1례.여치료전상비,환자적곡병전안매、곡초전안매균유하강,단하강정도불명현(P>0.05),무통계학의의;술후1주환자혈소판화백세포계수여치료전상비유흔대정도제고(P<0.05),차이유통계학의의.결론 비절제술치료비동맥부분전새후비공능항진복발효과량호,술중수자세분리,소심주위기관적부손상;술후능구유효소제비공능항진증상,대간공능손상소,치득림상추엄.
Objective To investigate the clinical curative effect of splenectomy for the treatment of the patients with hypersplenism recurrence after partial splenic arterial embolization.Methods Twenty eight patients with hypersplenism recurrence after partial splenic arterial embolization underwent splenectomy combined with periesophagogastric devascularization from August 2004 to August 2014. The clinical outcome was analyzed.Results All patients were successfully operated. Adhesion of spleen to peripheral organism of colon, stomach and diaphragm was seperated intraoperatively, with 2 stomach injury and 1 diaphragm injury. Operation time was(165.73±48.79)min; The intraoperative blood lose and postoperative blood lose was (1100±200)ml and (840.25+209.86) ml respectively. Spleen specimen weighed (375.81±108.37) g. There were 14 cases with reactive pleural effusion and 1 patient with pancreatic fistula after operation. The level of AST and ALT did not obviously decrease after operation without statistically significance (P>0.05).But the amount of platelet and white blood cell counts obviously increased 1 week after operation with statistically significance(P<0.05).Conclusion Splenectomy is an effective therapeutic measure for the treatment of the patients with hypersplenism recurrence after partial splenic arterial embolism. The patients with hypersplenism relieved after operation with less liver function damage. It should be recommended to apply. But carefulness should be taken to avoid the injury of the peripheral tissue during operation.
