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中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (05) : 405 -409. doi: 10.3877/cma.j.issn.2095-3232.2019.05.007

所属专题: 文献

临床研究

"隧道法"腹腔镜脾切除术治疗巨脾
唐勇1, 万赤丹1,()   
  1. 1. 430022 武汉,华中科技大学同济医学院附属协和医院肝胆外科
  • 收稿日期:2019-05-20 出版日期:2019-10-10
  • 通信作者: 万赤丹
  • 基金资助:
    国家自然科学基金面上项目(81672919)

Tunnel-building laparoscopic splenectomy in treatment of giant spleen

Yong Tang1, Chidan Wan1,()   

  1. 1. Department of Hepatobiliary Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2019-05-20 Published:2019-10-10
  • Corresponding author: Chidan Wan
  • About author:
    Corresponding author: Wan Chidan, Email:
引用本文:

唐勇, 万赤丹. "隧道法"腹腔镜脾切除术治疗巨脾[J]. 中华肝脏外科手术学电子杂志, 2019, 08(05): 405-409.

Yong Tang, Chidan Wan. Tunnel-building laparoscopic splenectomy in treatment of giant spleen[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(05): 405-409.

目的

探讨"隧道法"腹腔镜脾切除术(TLS)治疗巨脾的效果。

方法

回顾性分析2017年1月至2018年6月华中科技大学同济医学院附属协和医院收治的113例行单纯TLS患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男69例,女44例;平均年龄(47±14)岁。根据脾脏大小及重量将患者分为巨脾组(42例)和非巨脾组(71例)。术中经脾蒂后下缘间隙建立的脾后隧道,先离断脾蒂再处理脾周韧带。两组手术时间、术中出血量、脾脏取出时间等围手术期情况比较采用t检验,率的比较采用χ2检验或Fisher确切概率法。

结果

两组患者均顺利完成手术,均无术中中转开腹。巨脾组手术时间、脾脏取出时间分别为(83±5)、(28±5)min,明显长于非巨脾组的(63±8)、(15±3)min(t=17.860,15.464;P<0.05)。两组术中出血量、术后首次进食时间、术后住院时间、围手术期并发症发生率差异均无统计学意义(P>0.05)。

结论

TLS不仅适用于常规脾切除术,在巨脾切除术中同样是安全、有效的手术方式。

Objective

To evaluate the clinical efficacy of tunnel-building laparoscopic splenectomy (TLS) in the treatment of giant spleen.

Methods

Clinical data of 113 patients undergoing single TLS in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2017 to June 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 69 patients were male and 44 female, aged (47±14) years on average. According to the spleen size and weight, all patients were divided into the giant spleen group (n=42) and non-giant spleen group (n=71). Intraoperatively, the retrosplenic tunnel was established through the gap between the posterior and inferior margins of splenic pedicle. The splenic pedicle was initially dissected and subsequently the perisplenic ligament was treated. The perioperative conditions, such as operation time, intraoperative blood loss, spleen extraction time, were statistically compared between two groups by t test. The rate comparison was performed by Chi-square test or Fisher's exact probability test.

Results

All patients completed the operation successfully, and no case was converted to open surgery during the operation. In the giant spleen group, the operation time and spleen extraction time were (83±5) min and (28±5) min, significantly longer than (63±8) min and (15±3) min in the non-giant spleen group (t=17.860, 15.464; P<0.05). No significant difference was observed in the intraoperative blood loss, the first intaking time after surgery, length of postoperative hospital stay and incidence of perioperative complications between two groups (P>0.05).

Conclusions

TLS is not only suitable for routine splenectomy, but also safe and efficacious for giant splenectomy.

表1 巨脾组和非巨脾组患者术前一般资料比较(例)
表2 巨脾组和非巨脾组患者围手术期情况比较(±s
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