腹腔镜脾切除术联合术中自体输血治疗外伤性脾破裂的疗效研究

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1、腹腔镜脾切除术联合术中自体输血治疗外伤性脾破裂的疗效研究范瑞芳肖毅许树林党政上官建营张超吕志诚牛刚李月胜解放军兰州总医院肝胆外科摘要：目的:研宄腹腔镜脾切除术联合术中自体输血治疗外伤性脾破裂的可行性及安全性。方法:选取2012-022016-10外伤性脾破裂急诊行腹腔镜脾切除术患者31例，术中自体血液冋输，观察脾动脉阻断吋间、总手术时间、自体输血量、术后腹腔引流量、住院时间、并发症等临床指标。结果:31例患者均诊断为外伤性脾破裂,II级损伤5例，III级损伤20例，IV级损伤6例。2例合并胰尾部损伤，4例左肾损伤，9例左侧多发肋骨骨折，4例胸腔积血或血气胸。12例术

2、前血流动力学稳定，其余19例抗休克治疗后平稳。31例均成功实施腹腔镜脾切除术及术中自体输血，无中转开腹。2例行胰尾部修补术，3例行左侧胸腔闭式引流术，1例行胸腔穿刺引流术。脾动脉阻断时间（18.5±3.5）min,总手术时间（125±36）min,自体输血量（1456±305）ml,术后腹腔总引流量（126±58）ml,术后住院时间（9.5±2.1）d。31例均未输兄体血，术后未发生大出血、感染、胰漏等并发症。结论:腹腔镜脾切除术联合术中自体输血治疗血流动力学稳定的外伤性脾破裂安全可行，具有恢复快、住院吋间短、术后并发症少等优点。关键词：脾脏损伤;脾脏切除术;腹腔镜

3、;自体输血;作者简介：范瑞芳（1965—），男，主任医师，硕导，E-mail:ruifang.fan@yahoo.com收稿日期：2017-08-23EffectoflaparoscopicsplenectomycombinedwithintraoperativeautotransfusionfortraumaticsplenicruptureFANRuifangXIAOYiXUShulinDepartmentofHepatobiliarySurgery，LanzhouGeneralHospitalofPLA;Abstract：Objective:Tostudyth

4、efeasibilityandsafetyoflaparoscopicsplenectomy(LS)combinedwithintraoperativeautotransfusion(IAT)forthetreatmentoftraumaticsplenicrupture.Methods:Thirty-onepatientswithtraumaticsplenicruptureundergoingLSandIATwereadmittedfromFebruary2012toOctober2016.Theclinicalindexwereobservedandanaly

5、zed,includingthetimeofsplenicarteryblock,totaloperationtime,autologousbloodtransfusionvolume,postoperativeabdominaldrainagevolume,lengthofhospitalstayandcomplications.Results:Allthepatientswerediagnosedastraumaticsplenicrupture.ThesplenicinjurieswereclassifiedasgradeIIin5，gradeIIIin20，

6、andgradeIVin6patients.Andpancrcatictailinjuryin2,leftkidneyinjuryin4，leftmultifracturesribsin9,andhemothoraxorhemopneumothoraxin4.Thepreoperativehemodynamicsstabilityin12patients,andtheotherl9patientswerestableafterpreoperativeantishocktherapy.TheLSandIATweresuccessfullyimplcmcntatedin

7、31patients,withoutconversiontolaparotomy.Twopatientsweregivenpancreatictailrepair,2patientsweregivenleftthoracicclosedrainage，and1patientwasgiventhoracentesis.Themeantimeofsplenicarteryblockwas(18.5±3.5)minutes,themeantotaloperationtimewas(125±36)minutes,themeanautologousbloodtransfu