腹腔镜二级脾蒂离断法脾切除术在肥胖病人中的应用
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摘要
目的研究腹腔镜二级脾蒂离断法脾切除术在肥胖病人中的应用。方法回顾性分析武汉科技大学附属孝感医院肝胆外科2015年4月至2018年10月收治的37例肝硬化门静脉高压症病人应用二级脾蒂离断法行腹腔镜脾切除术的临床资料。按照体质量指数(BMI)将病人分为两组:肥胖组(BMI≥28 kg/m~2)和非肥胖组(BMI<28 kg/m~2)。比较两组病人手术时间、术中出血量、中转开腹手术发生率、住院时间以及术后并发症发生情况。结果肥胖病人手术时间、术中出血量高于非肥胖组[分别为(176.3±28.7) min比(147.9±23.5) min、(213.2±23.4) ml比(192.6±19.7) ml,P<0.05],而两组中转开腹手术发生率、住院时间、术后并发症发生率差异均无统计学意义[16.7%比4.0%、(9.7±1.6) d比(9.1±1.9) d、33.3%比8.0%,均P>0.05]。结论腹腔镜二级脾蒂离断法脾切除术在肥胖病人中应用是安全、可行的,但可能会增加手术风险,术中应谨慎操作。
Objective To study the application of laparoscopic splenectomy in the obese patients by the amputation of secondary splenic pedicel.Methods The clinical data of 37 patients with cirrhosis and portal hypertension who underwent laparoscopic splenectomy with the amputation of secondary structures of the spleen pedicel from April 2015 to October 2018 were retrospectively analyzed.Patients were divided into two groups according to body mass index(BMI): obese(BMI≥28 kg/m~2) and non-obese(BMI<28 kg/m~2).The operation time,blood loss,conversion rates,length of stay and postoperative complications were analyzed and compared.Results The obese group was worse than non-obese group in the operation time and blood loss(176.3±28.7 min vs.147.9±23.5 min, 213.2±23.4 ml vs.192.6±19.7 ml, P<0.05). There was no significant differences between the two groups in the conversion rates, the length of stay and postoperative complications(16.7%vs. 4.0%,9.7±1.6 d vs. 9.1±1.9 d、33.3%vs. 8.0%,P>0.05). Conclusion The application of laparoscopic splenectomy by the amputation of secondary splenic pedicel was safe and feasible in the obese patients, and this kind of surgery should be performed with caution as it may increase surgical risk.
Objective To study the application of laparoscopic splenectomy in the obese patients by the amputation of secondary splenic pedicel.Methods The clinical data of 37 patients with cirrhosis and portal hypertension who underwent laparoscopic splenectomy with the amputation of secondary structures of the spleen pedicel from April 2015 to October 2018 were retrospectively analyzed.Patients were divided into two groups according to body mass index(BMI): obese(BMI≥28 kg/m~2) and non-obese(BMI<28 kg/m~2).The operation time,blood loss,conversion rates,length of stay and postoperative complications were analyzed and compared.Results The obese group was worse than non-obese group in the operation time and blood loss(176.3±28.7 min vs.147.9±23.5 min, 213.2±23.4 ml vs.192.6±19.7 ml, P<0.05). There was no significant differences between the two groups in the conversion rates, the length of stay and postoperative complications(16.7%vs. 4.0%,9.7±1.6 d vs. 9.1±1.9 d、33.3%vs. 8.0%,P>0.05). Conclusion The application of laparoscopic splenectomy by the amputation of secondary splenic pedicel was safe and feasible in the obese patients, and this kind of surgery should be performed with caution as it may increase surgical risk.
引文
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[5] 肖昌武,邱容,戴毅,等.应用二级脾蒂离断法行腹腔镜脾切除术的临床研究[J].腹腔镜外科杂志,2015,20(8):574-576.
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[10] 李旭刚,张耀明,温治强.二级脾蒂离断法行腹腔镜脾切除术的临床效果观察[J].中国实用医刊,2017,44(7):39-41.DOI:10.3760/cma.j.issn.1674-4756.2017.07.013.
[11] Al-Raimi K,Zheng SS.Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients:a meta-analysis[J].Hepatobiliary Pancreatic Dis Int,2016,15(1):14-20.DOI:10.1016/S1499-3872(16)60053-X.
[12] Kawanaka H,Akahoshi T,Kinjo N,et al.Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension[J].J Ame Col Surg,2015,221(2):354-366.DOI:10.1016/j.jamcollsurg.2015.04.011.
[13] 罗永平.二级脾蒂离断法脾切除术在肝硬化脾功能亢进中的应用[J].河北医学,2011,17(12):1579-1581.DOI:10.3969/j.issn.1006-6233.2011.12.06.
[14] 王广义,纪柏,陈国富.腹腔镜脾切除术技术难点及处理方法的合理选择[J].腹腔镜外科杂志,2011,16(11):801-803.
[15] Poulin E,Thibault C,Mamazza J,et al.Clinical experience and role of preoperative splenic artery embolization[J].Surg Laparosc Endosc,1993,3(6):445-450.
[16] 陶亮,翁晓晖,孔晓武,等.腹腔镜原位二级脾蒂离断法在外伤性脾破裂脾切除中的应用[J].中国微创外科杂志,2015,15(5):389-391.DOI:10.3969/j.issn.1009-6604.2015.05.002.
[17] 原春辉,裴琛,贾易木,等.腹腔镜脾切除术63例[J].中华普通外科杂志,2013,28(3):208-211.DOI:10.3760/cma.j.issn.1007-631X.2013.03.012.
[18] 曹峻,邰沁文,谷昊,等.二级脾蒂离断法在腹腔镜脾切除术中的临床应用[J/CD].中华腔镜外科杂志(电子版),2014,7(3):189-191.DOI:10.3877/cma.j.issn.1674-6899.2014.03.007.
[19] Liu DL,Xia S,Xu W,et al.Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy[J].Surgery,1996,119(1):27-33.DOI:10.1016/S0039-6060(96)80209-1.
[20] Fujioka S,Yoshida K,Okamoto T,et al.Stapleless laparoscopic splenectomy using harmonic scalpel by 2-step sealing[J].Int Surg,2013,98(4):385-387.DOI:10.9738/intsurg-d-13-00035.1.
[21] 王汉宁,向国安,陈开运,等.二级脾蒂离断法在腹腔镜脾切除术的应用[J].中国微创外科杂志,2006,6(9):691-692.DOI:10.3969/j.issn.1009-6604.2006.09.022.
[22] 周进学,展翔宇,李庆军,等.二级脾蒂离断在腹腔镜脾切除术中的应用[J].中华普通外科杂志,2017,32(2):119-121.DOI:10.3760/cma.j.issn.1007-631X.2017.02.008.
[23] 许焕建,孙学征,傅宏,等.腹腔镜下二级脾蒂离断法脾切除术中出血的预防[J].中国内镜杂志,2014,20(4):443-445.
[24] Yoshikawa K,Shimada M,Kurita N,et al.Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer[J].Surg Endosc,2011,25(12):3825-3830.DOI:10.1007/s00464-011-1798-7.
[25] Heneghan HM,Annaberdyev S,Attaluri V,et al.Obesity does not adversely affect outcomes after laparoscopic splenectomy [J].Am J Surg,2013,206(1):52-58.DOI:10.1016/j.amjsurg.2012.07.041.
[26] 李永彬,蔡云强,王昕,等.选择性脾蒂阻断在腹腔镜脾脏部分切除术中的应用[J].中华普通外科杂志,2017,32(2):122-125.DOI:10.3760/cma.j.issn.1007-631X.2017.02.009.
[27] 郑成竹.腹腔镜脾切除术的手术技巧[J].腹腔镜外科志,2009,14(5):323-325.
[28] 谭敏,郑朝旭,羲彦,等.手术体位对腹腔镜脾切除术操作的影响[J].中国实用外科杂志,2001,21(9):536-538.DOI:10.3321/j.issn:1005-2208.2001.09.012.
[29] 李谦,周大艳,刘彬.全腹腔镜脾切除术中出血原因的分析[J].腹腔镜外科杂志,2015,20(3):208-211.
[2] Habermalz B,Sauerland S,Decker G,et al.Laparoscopic splenectomy:the clinical practice guidelines of the European Association for Endoscopic Surgery(EAES)[J].Surg Endosc,2008,22(4):821-848.DOI:10.1007/s00464-007-9735-5.
[3] 冯剑平,王卫东,梁智强,等.二级脾蒂离断法与Endo-GIA法在腹腔镜脾切除术中临床对照研究[J].岭南现代临床外科,2011,11(6):426-428.DOI:10.3969/j.issn.1009-976X.2011.06.007.
[4] 汤晓东,刘双海,周一夫,等.二级脾蒂离断法腹腔镜脾切除术15例初步体会[J].东南大学学报(医学版),2012,31(5):625-627.DOI:10.3969/j.issn.1671-6264.2012.05.025.
[5] 肖昌武,邱容,戴毅,等.应用二级脾蒂离断法行腹腔镜脾切除术的临床研究[J].腹腔镜外科杂志,2015,20(8):574-576.
[6] Kim KH,Kim Mc,Jung GJ.Risk factors associated with delayed gastric emptying after subtotal gastrectomy with Billroth-1 anastomosis using circular for early gastric cancer patients[J].J Korean Surg Soc,2012,83(5):274-280.DOI:10.4174/jkss.2012.83.5.274.
[7] Michailidou M,Sacco Casamassima MG,Goldstein SD,et al.The impact of obesity on laparoscopic appendectomy:Results from the ACS National Surgical Quality Improvement Program pediatric database[J].J Ped Surg,2015,50(11):1880-1884.DOI:10.1016/j.jpedsurg.2015.07.005.
[8] 中华人民共和国卫生部疾病控制司.中国成人超重和肥胖症预防与控制指南[M].北京:人民卫生出版社,2006:2.
[9] Han ES,You YK,Kim DG,et al.Clinical significance of single-port laparoscopic splenectomy:comparison of single-port and multiport laparoscopic procedure[J].Ann Surg Treat Res,2015,89(2):55-60.DOI:10.4174/astr.2015.89.2.55.
[10] 李旭刚,张耀明,温治强.二级脾蒂离断法行腹腔镜脾切除术的临床效果观察[J].中国实用医刊,2017,44(7):39-41.DOI:10.3760/cma.j.issn.1674-4756.2017.07.013.
[11] Al-Raimi K,Zheng SS.Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients:a meta-analysis[J].Hepatobiliary Pancreatic Dis Int,2016,15(1):14-20.DOI:10.1016/S1499-3872(16)60053-X.
[12] Kawanaka H,Akahoshi T,Kinjo N,et al.Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension[J].J Ame Col Surg,2015,221(2):354-366.DOI:10.1016/j.jamcollsurg.2015.04.011.
[13] 罗永平.二级脾蒂离断法脾切除术在肝硬化脾功能亢进中的应用[J].河北医学,2011,17(12):1579-1581.DOI:10.3969/j.issn.1006-6233.2011.12.06.
[14] 王广义,纪柏,陈国富.腹腔镜脾切除术技术难点及处理方法的合理选择[J].腹腔镜外科杂志,2011,16(11):801-803.
[15] Poulin E,Thibault C,Mamazza J,et al.Clinical experience and role of preoperative splenic artery embolization[J].Surg Laparosc Endosc,1993,3(6):445-450.
[16] 陶亮,翁晓晖,孔晓武,等.腹腔镜原位二级脾蒂离断法在外伤性脾破裂脾切除中的应用[J].中国微创外科杂志,2015,15(5):389-391.DOI:10.3969/j.issn.1009-6604.2015.05.002.
[17] 原春辉,裴琛,贾易木,等.腹腔镜脾切除术63例[J].中华普通外科杂志,2013,28(3):208-211.DOI:10.3760/cma.j.issn.1007-631X.2013.03.012.
[18] 曹峻,邰沁文,谷昊,等.二级脾蒂离断法在腹腔镜脾切除术中的临床应用[J/CD].中华腔镜外科杂志(电子版),2014,7(3):189-191.DOI:10.3877/cma.j.issn.1674-6899.2014.03.007.
[19] Liu DL,Xia S,Xu W,et al.Anatomy of vasculature of 850 spleen specimens and its application in partial splenectomy[J].Surgery,1996,119(1):27-33.DOI:10.1016/S0039-6060(96)80209-1.
[20] Fujioka S,Yoshida K,Okamoto T,et al.Stapleless laparoscopic splenectomy using harmonic scalpel by 2-step sealing[J].Int Surg,2013,98(4):385-387.DOI:10.9738/intsurg-d-13-00035.1.
[21] 王汉宁,向国安,陈开运,等.二级脾蒂离断法在腹腔镜脾切除术的应用[J].中国微创外科杂志,2006,6(9):691-692.DOI:10.3969/j.issn.1009-6604.2006.09.022.
[22] 周进学,展翔宇,李庆军,等.二级脾蒂离断在腹腔镜脾切除术中的应用[J].中华普通外科杂志,2017,32(2):119-121.DOI:10.3760/cma.j.issn.1007-631X.2017.02.008.
[23] 许焕建,孙学征,傅宏,等.腹腔镜下二级脾蒂离断法脾切除术中出血的预防[J].中国内镜杂志,2014,20(4):443-445.
[24] Yoshikawa K,Shimada M,Kurita N,et al.Visceral fat area is superior to body mass index as a predictive factor for risk with laparoscopy-assisted gastrectomy for gastric cancer[J].Surg Endosc,2011,25(12):3825-3830.DOI:10.1007/s00464-011-1798-7.
[25] Heneghan HM,Annaberdyev S,Attaluri V,et al.Obesity does not adversely affect outcomes after laparoscopic splenectomy [J].Am J Surg,2013,206(1):52-58.DOI:10.1016/j.amjsurg.2012.07.041.
[26] 李永彬,蔡云强,王昕,等.选择性脾蒂阻断在腹腔镜脾脏部分切除术中的应用[J].中华普通外科杂志,2017,32(2):122-125.DOI:10.3760/cma.j.issn.1007-631X.2017.02.009.
[27] 郑成竹.腹腔镜脾切除术的手术技巧[J].腹腔镜外科志,2009,14(5):323-325.
[28] 谭敏,郑朝旭,羲彦,等.手术体位对腹腔镜脾切除术操作的影响[J].中国实用外科杂志,2001,21(9):536-538.DOI:10.3321/j.issn:1005-2208.2001.09.012.
[29] 李谦,周大艳,刘彬.全腹腔镜脾切除术中出血原因的分析[J].腹腔镜外科杂志,2015,20(3):208-211.