[1]徐胜前 秦勇＊ 叶冠雄 吴成军 王世 潘德标.脾功能亢进合并胆囊结石完全腹腔镜与开腹手术的对比研究[J].中国微创外科杂志,2014,14(6):509-511.
Xu Shengqian,Qin Yong,Ye Guangxiong,et al.A Comparison of Laparoscopic and Open Surgery in the Treatment of Gallstones Combined with Hypersplenism[J].Chinese Journal of Minimally Invasive Surgery,2014,14(6):509-511.
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脾功能亢进合并胆囊结石完全腹腔镜与开腹手术的对比研究(
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]
- 卷:
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14
- 期数:
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2014年6期
- 页码:
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509-511
- 栏目:
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- 出版日期:
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2014-06-20
文章信息/Info
- Title:
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A Comparison of Laparoscopic and Open Surgery in the Treatment of Gallstones Combined with Hypersplenism
- 作者:
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徐胜前 秦勇＊ 叶冠雄 吴成军 王世 潘德标
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温州医科大学附属第六医院浙江省丽水市人民医院肝胆胰外科，丽水323000
- Author(s):
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Xu Shengqian; Qin Yong; Ye Guangxiong; et al. Corresponding author:Qin Yong; Email:bingmayong811@163.com
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Department of Hepatobiliary and Pancreatic Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui 32300, China
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- 关键词:
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腹腔镜; 脾脏切除术; 胆囊切除术
- Keywords:
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Laparoscope; Splenectomy; Cholecystectomy
- 分类号:
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R657.6;R657.4
- 文献标志码:
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A
- 摘要:
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目的比较完全腹腔镜与开腹手术治疗脾功能亢进合并胆囊结石的临床疗效。方法2008年12月～2012年12月对40例脾亢合并胆囊结石分别行完全腹腔镜和开腹脾脏联合胆囊切除手术，比较2组手术时间、术中出血量、术后并发症和术后住院时间等。结果腹腔镜组手术时间（228.5±15.0）min与开腹组（227.5±14.2）min无统计学差异（t=-0.217，P=0.830），腹腔镜组术中出血量（817.8±34.3）ml，显著少于开腹组术中出血量（875.6±70.7）ml（t=3.295，P=0002）。2组均无术中并发症。腹腔镜组术后胸腔积液3例，穿刺孔出血1例；开腹组术后胸腔积液2例，切口感染2例，腹腔积液1例；2组并发症发生率分别为20%（4/20）和25%（5/20），无统计学差异（Fisher’s检验，P=1.000）。腹腔镜组住院时间（13.0±0.9）d，显著短于开腹组（14.0±1.1）d（t=3.147，P=0.003）。40例术后随访3～15个月，平均8个月，2组脾功能亢进均得到纠正，白细胞、血小板、血红蛋白恢复正常；腹腔镜组6例，开腹组5例门静脉血栓形成，口服华法令片和肠溶阿司匹林胶囊控制。结论完全腹腔镜脾切除联合胆囊切除治疗脾功能亢进合并胆囊结石在疗效上与传统开腹手术相媲美，手术创伤小，术后恢复快，具有明显的微创优势。
- Abstract:
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ObjectiveTo compare the clinical effects of laparoscopic and open operation in the treatment of gallstones with hypersplenism.MethodsA retrospective analysis of 40 cases of gallstones combined with hypersplenism from December 2008 to December 2012 was performed. These cases were randomly divided into laparoscopic group and open group, respectively. The operation time, blood loss, postoperative complications, and postoperative hospitalization time were compared.ResultsThe operation time of laparoscopic group (228.5±15.0) min had no significant difference compared with open group (227.5±14.2) min (t=-0.217, P=0.830). The amount of blood loss of laparoscopic group (817.8±34.3) ml was less than that of the open group (875.6±70.7) ml, with significant difference (t=3.295, P=0.002). No intraoperative complications happened in both groups. After laparoscopic surgery, there were 3 cases of pleural effusion and 1 case of puncture site bleeding; whereas after open surgery, there were 2 cases of pleural effusion, 2 cases of incision infection, and 1 case of peritoneal effusion. The complication rates were 20% (4/20) and 25% (5/20), respectively, without significant difference (Fisher’s test, P=1.000) between the two groups. The length of hospital stay of laparoscopic group (13.0±0.9) d was shorter than that of open group (14.0±1.1) d, with statistically significance (t=3.147, P=0.003). All the 40 cases were followed up for 3-15 months (mean, 8 months), during which hypersplenism was relieved in both groups with normal white blood cells, platelets, and hemoglobin. Portal vein thrombosis occurred in 6 patients of laparoscopic group and 5 patients of open group, respectively, who were treated by oral warfarin tablets and entericcoated aspirin capsules. ConclusionLaparoscopic operation in the treatment of gallstones with hypersplenism has no significant difference in clinical effects compared with open operation, bearing advantages of quick postoperative recovery and minimal invasion.
参考文献/References:
[1]刘兴贵，胡康，杨能红．30例肝硬化合并胆石症外科治疗体会．重庆医学，2009，38(2)：243-248．
[2]洪德飞，严力锋，沈来根，等．完全腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症的疗效评价.中华普通外科杂志，2007，22（11）：821-823.
[3]徐胜前，叶冠雄，吴成军.腹腔镜手术治疗脾功能亢进合并胆囊结石36例.中国微创外科杂志，2011，11（2）：153-154.
[4]洪德飞，郑雪咏，严力锋，等．免切割闭合器完全腹腔镜巨脾切除联合贲门周围血管离断术．中国微创外科杂志，2008，8(1)：21-23．
备注/Memo
- 备注/Memo:
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＊通讯作者，Email:bingmayong811@163.com
更新日期/Last Update:
2014-12-08