选择性脾动脉栓塞术治疗外伤性脾破裂的临床研究

金晶; 陶亮

doi:10.16766/j.cnki.issn.1674-4152.002590

选择性脾动脉栓塞术治疗外伤性脾破裂的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002590

金晶^1, ,,
陶亮²

1.
衢州市人民医院普外科，浙江衢州 324000
2.
海宁市中心医院普外科，浙江嘉兴 314400

基金项目:

浙江省医药卫生科技计划项目 2018RC076

详细信息

通讯作者:
金晶, E-mail: 594jj@163.com

中图分类号: R657.62
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出版历程
- 收稿日期: 2022-03-07

Clinical effect of selective splenic artery embolization in the treatment of traumatic splenic rupture

JIN Jing^{1
, ,},
TAO Liang²

1.
Department of General Surgery, Quzhou People' s Hospital, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的评价选择性脾动脉栓塞术用于治疗外伤性脾破裂的有效性和安全性。方法以2017年3月—2020年3月衢州市人民医院诊治的120例外伤性脾破裂患者为研究对象，按照手术方式不同分为对照组(60例)和研究组(60例)。对照组实施腹腔镜下脾脏部分切除术，研究组实施选择性脾动脉栓塞术。记录患者手术时间、术中出血量、引流管留置时间、术后肛门首次排气时间、术后首次下床时间和住院时间等手术治疗指标，检测患者手术前后外周血IgM、IgA和IgG水平，观察患者并发症情况。结果研究组患者手术时间、术中出血量、引流管留置时间、术后肛门首次排气时间、术后首次下床时间和住院时间[(94.73±10.62)min，(196.49±24.62)mL，(2.25±0.36)d，(2.65±0.39)d，(2.84±0.41)d和(5.29±0.61)d]均显著少于对照组[(128.52±12.03)min，(339.62±40.81)mL，(3.57±0.49)d，(3.86±0.51)d，(3.91±0.54)d和(7.46±0.82)d，均P < 0.05]；术前和术后3个月，2组患者外周血IgM、IgA和IgG比较差异无统计学意义(均P>0.05)；研究组患者围术期并发症总发生率(6.67%)显著低于对照组(21.67%，χ²=5.551，P=0.018)。结论选择性脾动脉栓塞术可有效减轻外伤性脾破裂患者手术创伤，缩短术后康复周期，对患者免疫功能影响较小，降低术后并发症发生风险。
- 外伤性脾破裂 /
- 脾脏部分切除术 /
- 选择性脾动脉栓塞术 /
- 康复周期 /
- 免疫功能 /
- 并发症
Abstract: Objective To evaluate the efficacy and safety of selective splenic artery embolization in the treatment of traumatic splenic rupture. Methods A total of 120 patients with traumatic splenic rupture in Quzhou People ' s Hospital from March 2017 to March 2020 were selected. They were divided into control group (60 cases) and study group (60 cases) in accordance with different operation methods. Laparoscopic partial splenectomy was performed in the control group and selective splenic artery embolization was performed in the study group. The operation time, intraoperative blood loss, indwelling time of drainage tube, first postoperative anal exhaust time, first postoperative ambulation time and hospitalisation time were recorded. The levels of IgM, IgA, IgG and other immune factors in peripheral blood before and after operation were detected. The complications within 12 months after operation were followed up. Results The operation time, intraoperative bleeding, indwelling time of drainage tube, first exhaust time of anus after operation, first time out of bed and hospital stay after operation in the study group [(94.73±10.62) min, (196.49±24.62) mL, (2.25±0.36) d, (2.65±0.39) d, (2.84±0.41) d and (5.29±0.61) d, respectively] were significantly less than those in the control group [(128.52±12.03) min, (339.62±40.81) mL, (3.57±0.49) d, (3.86±0.51) d, (3.91±0.54) d and (7.46±0.82) d, respectively, all P < 0.05]. No significant difference was found in the levels of IgM, IgA and IgG between the two groups before and 3 months after operation (all P>0.05). The overall incidence of postoperative complications in the study group (6.67%) was significantly lower than that in the control group (21.67%, χ²=5.551, P=0.018). Conclusion Selective splenic artery embolization could effectively reduce the surgical trauma of patients with traumatic splenic rupture, shorten the postoperative rehabilitation cycle, less affect the immune function of patients and reduce the risk of postoperative complications.
- Traumatic rupture of spleen /
- Partial splenectomy /
- Selective splenic artery embolization /
- Rehabilitation cycle /
- Immunity /
- Complication
利益冲突 无

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表 1 2组外伤性脾破裂患者手术治疗指标比较(x±s)

Table 1. Comparison of surgical treatment indexes between two groups of patients with traumatic splenic rupture(x±s)

组别	例数	手术时间(min)	术中出血量(mL)	引流管留置时间(d)	术后肛门首次排气时间(d)	术后首次下床时间(d)	住院时间(d)
对照组	60	128.52±12.03	339.62±40.81	3.57±0.49	3.86±0.51	3.91±0.54	7.46±0.82
研究组	60	94.73±10.62	196.49±24.62	2.25±0.36	2.65±0.39	2.84±0.41	5.29±0.61
t值		16.245	23.225	17.067	14.487	12.123	16.412
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 2组外伤性脾破裂患者手术前后免疫学指标情况比较(x±s，g/L)

Table 2. Comparison of immunological indexes before and after operation between two groups of patients with traumatic splenic rupture(x±s, g/L)

组别	例数	IgM		IgA		IgG
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
对照组	60	2.34±0.47	2.19±0.45	2.63±0.40	2.51±0.37	12.54±1.42	12.39±1.35
研究组	60	2.39±0.49	2.23±0.41	2.67±0.43	2.49±0.39	12.69±1.45	12.17±1.40
t值		0.588	0.528	0.568	0.240	0.570	0.868
P值		0.558	0.599	0.571	0.811	0.569	0.387

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表 3 2组外伤性脾破裂患者围术期并发症情况比较[例(%)]

Table 3. Comparison of perioperative complications in patients with traumatic splenic rupture between two groups [cases (%)]

组别	例数	胰瘘	脾蒂出血	脾热	切口感染	总发生
对照组	60	3(5.00)	5(8.33)	3(5.00)	2(3.33)	13(21.67)
研究组	60	1(1.67)	2(3.33)	1(1.67)	0	4(6.67)
注：2组患者围术期并发症总发生率比较，χ²=5.551，P=0.018。

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