中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (1): 53-57.doi: 10.12007/j.issn.0258-4646.2018.01.012

• 论著 • 上一篇    下一篇

脾破裂经脾切除治疗后加行大网膜自体脾片种植的临床疗效分析

汪海洋1, 陈树军1, 刘汝斌2   

  1. 1. 沈阳医学院附属中心医院普外四科, 沈阳 110024;
    2. 中国人民解放军 92819部队卫生院, 辽宁 大连 116600
  • 收稿日期:2017-05-25 出版日期:2018-01-30 发布日期:2017-12-23
  • 通讯作者: 汪海洋 E-mail:4603515@qq.com
  • 作者简介:汪海洋(1983-),男,主治医师,硕士.

Efficacy of omental implantation of autologous splenic segments after splenectomy for traumatic rupture

WANG Haiyang1, CHENG Shujun1, LIU Rubin2   

  1. 1. Department of the 4th General Surgery, the Central Affiliated Hospital of Shenyang Medical College, Shenyang 110024, China;
    2. Health Clinics, 92819 Forces, People's Liberation Army of China, Dalian 116600, China
  • Received:2017-05-25 Online:2018-01-30 Published:2017-12-23

摘要: 目的 探讨严重外伤性脾破裂经脾切除治疗后行大网膜自体脾片种植的临床疗效,为本术式的可行性和必要性提供临床依据。方法 选取沈阳医学院附属中心医院2014年7月至2016年8月收治的42例严重外伤性脾破裂患者,分为观察组(23例)与对照组(19例)。患者或其家属签署知情同意书,并获得我院医学伦理委员会批准。对照组行常规脾切除术,观察组在脾切除后行大网膜自体脾片种植。结果 观察组的手术时间显著长于对照组(P<0.05),而术中出血量、术后进食时间及住院时间2组比较差异均无统计学意义(均P>0.05);观察组术后切口感染发生率显著低于对照组(P<0.05);观察组患者种植脾片全部显影良好;术后30 d内2组患者血小板均不同程度偏高,观察组增高程度显著低于对照组,术后3,7,14,30 d组间比较均有统计学意义(P<0.05);观察组术后28 d IgG、IgM、IgA指标显著高于对照组(P<0.01);观察组术后14,28 d CD3+与CD4+/CD8+指标于均较对照组显著增高(P<0.01)。结论 严重外伤性脾破裂经脾切除治疗后行大网膜自体脾片种植可取得良好的临床疗效,具有较高的可行性与必要性。

关键词: 严重外伤性脾破裂, 自体脾片种植, 脾切除术, 大网膜

Abstract: Objective To evaluate the feasibility and efficacy of autologous splenic segment implantation after splenectomy for traumatic rupture. Methods This study included 42 patients with traumatic splenic rupture who were treated between July 2014 and August 2016 at the Affiliated Central Hospital of Shenyang Medical College. The patients were divided into an observation group (n=23) and a control group (n=19). Informed consent was provided by the patient or family members. The control group underwent routine splenectomy, and the observation group underwent implantation of autologous spleen segments after splenectomy. Results The operative time in the observation group was significantly longer than in the control group (P<0.05). The intraoperative blood loss, time to postoperative return to oral feeding, and length of hospital stay were not statistically different (P>0.05). The rate of postoperative wound infections in the observation group was significantly lower than in the control group (P<0.05). All spleen segments developed well in the observation group. At 30 postoperative days, platelets were increased in both groups, but the level in the observation group was significantly lower than in the control group (P<0.05). IgG, IgM, and IgA levels were significantly higher in the observation group than in the control group at 28 postoperative days (P<0.01). CD3+ and CD4+/CD8+ levels were significantly higher in the observation group than in the control group at 14 and 28 postoperative days (P<0.01). Conclusion Implantation of autologous spleen segments after splenectomy for trauma was feasible and effective.

Key words: severe traumatic rupture of spleen, implantation of autologous spleen, splenectomy, omentum

中图分类号: 

  • R641
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