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.docVIP

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 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的:研究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, 术中自体血液回输, 观察脾动脉阻断时间、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 (1 456±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例均未输异体血, 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、住院时间短、术后并发症少等优点。 关键词： 脾脏损伤; 脾脏切除术; 腹腔镜; 自体输血; 作者简介：范瑞芳 (1965—) , 男, 主任医师, 硕导, E-mail:ruifang.fan@ 收稿日期：2017-08-23 Effect of laparoscopic splenectomy combined with intraoperative autotransfusion for traumatic splenic rupture FAN Ruifang XIAO Yi XU Shulin Department of Hepatobiliary Surgery, Lanzhou General Hospital of PLA; Abstract： Objective:To study the feasibility and safety of laparoscopic splenectomy (LS) combined with intraoperative autotransfusion (IAT) for the treatment of traumatic splenic rupture.Methods:Thirty-one patients with traumatic splenic rupture undergoing LS and IAT were admitted from February 2012 to October 2016.The clinical index were observed and analyzed, including the time of splenic artery block, total operation time, autologous blood transfusion volume, postoperative abdominal drainage volume, length of hospital stay and complications.Results:All the patients were diagnosed as traumatic splenic rupture.The splenic injuries were classified as grade Ⅱ in 5, grade Ⅲ in 20, and grade Ⅳ in 6 patients.And pancreatictail injury in 2, left kidney injury in 4, left multi fractures ribs in 9, and hemothorax or hemopneumothorax in 4.The preoperative hemodynamics stability in 12 patients, and the other19 patients were stable after preoperative antishock therapy.The LS and IAT were successfully impleme