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目的探讨腹腔镜技术在脾脏恶性肿瘤的诊疗经验。方法回顾性复习笔者所在医院2009年1月至2015年7月期间行外科手术治疗的51例脾脏恶性肿瘤患者的临床资料。根据手术方式不同分为开腹组(n=18)和腹腔镜组(n=33)2组,收集并比较2组患者的术前、术中及术后的临床资料,比较开腹组及腹腔镜组围手术期各指标差异,包括患者的一般情况,术中情况(手术时间、术中出血量、围手术期输血情况)以及术后情况(住院时间,进食时间,以及胰瘘、再出血、腹腔及肺部感染发生率,术后是否镇痛等)。结果腹腔镜组与开腹组相比,腹腔镜组较开腹组手术时间明显缩短〔(103.64±16.92)min比(144.44±31.10)min,P=0.000〕,腹腔镜组术中出血量〔M(Q_(25),Q_(75))为60(50,100)〕较开腹组〔M(Q_(25),Q_(75))为150(115,210)〕明显减少(P=0.000),且腹腔镜组术后住院时间较开腹组明显缩短〔(13.61±9.91)d比(9.03±3.09)d,P=0.017〕,腹腔镜组出现发热及肺部感染人数较开腹组明显减少(P=0.010及P=0.003)。结论腹腔镜技术在脾脏恶性肿瘤切除手术中是可行的,腹腔镜技术的应用使手术时间缩短,具有术中出血少、住院时间缩短、术后并发症发生率低等优点,值得进一步推广应用。
Objective To explore the experience of laparoscopic diagnosis and treatment of splenic malignancies. Methods The clinical data of 51 patients with splenic malignancies treated surgically from January 2009 to July 2015 in our hospital were retrospectively reviewed. According to the different surgical methods, the patients were divided into two groups: laparotomy group (n = 18) and laparoscopic group (n = 33). The clinical data of two groups were collected and compared before and after operation. Laparoscopic perioperative perioperative differences in indicators, including the patient’s general situation, intraoperative (operation time, intraoperative blood loss, perioperative blood transfusion) and postoperative conditions (length of stay, eating time, and pancreatic fistula, and then Bleeding, the incidence of abdominal and lung infections, postoperative analgesia, etc.). Results Compared with the open group, laparoscopic group showed significantly shorter operation time than open group 〔(103.64 ± 16.92) min vs (144.44 ± 31.10) min, P = 0.000〕, laparoscopic group 60 (50,100) for M (Q_ (25), Q_ (75)) was significantly reduced (P = 0.000) compared to 150 (115,210) for the open group [M (Q_ (25) The postoperative hospital stay in laparoscopic group was significantly shorter than that in open group 〔(13.61 ± 9.91) d vs (9.03 ± 3.09) d, P = 0.017〕, and the number of fever and pulmonary infection in laparoscopic group was significantly lower than that in open group P = 0.010 and P = 0.003). Conclusions Laparoscopic surgery is feasible in resection of splenic malignant tumors. The application of laparoscopy shortens the operation time, has the advantages of less intraoperative bleeding, shorter hospital stay and lower postoperative complications, which is worthy of further application.