创伤性脾破裂急诊腹腔镜脾切除术的定位。

Hongjun Haung, Zhiqiang Haung, Ruofei Xiong, Xingcheng Meng, Ju Zhang
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摘要

研究目的研究设计:描述性研究。研究地点和时间:中国医科大学附属绍兴市中心医院普外科,浙江,2015年1月至2022年12月:方法:分析 96 例接受腹腔镜手术(LS)治疗外伤性脾破裂患者的临床资料。根据手术体位将患者分为两组。A 组(42 人)患者取右侧卧位,B 组(54 人)患者取仰卧位。比较了两组患者的手术时间、术中失血量、转为开腹手术率、术后住院时间和并发症发生率:结果:与 B 组相比,A 组手术时间更短(145.5 ± 24.4 分钟 vs. 169.0 ± 15.3 分钟,P = 0.0001),术中失血量更少(75.3 ± 35.3 毫升 vs. 110.3 ± 50.6 毫升,P = 0.0002)、较少转为开腹手术(2.4% vs. 16.7%,p = 0.023)、较少术后胰漏(7.1% vs. 24.1%,p = 0.027)和较少并发症(23.8% vs. 53.7%,p = 0.003);所有差异均显著。两组患者的术后住院时间、住院费用以及发热、术后腹腔感染、术后出血或静脉血栓等并发症的发生率均无统计学差异:结论:对于外伤性脾破裂的患者,右侧卧位是进行腹腔镜手术的最佳体位:腹腔镜 外伤性脾破裂 脾切除术 手术体位
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Positioning for Emergency Laparoscopic Splenectomy for Traumatic Splenic Rupture.

Objective: To determine whether the right-lateral decubitus or supine position is superior for emergency laparoscopy for traumatic splenic rupture.

Study design: Descriptive study. Place and Duration of the Study: Department of General Surgery, Central Hospital of Shaoxing, Affiliated Hospital of China Medical University, Zhejiang, China, from January 2015 to December 2022.

Methodology: Clinical data of 96 patients who underwent laparoscopic surgery (LS) for traumatic splenic rupture were analysed. The patients were divided into two groups according to surgical position. Group A (n = 42) patients were placed in the right-lateral decubitus position and Group B (n = 54) patients were placed in the supine position. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative length of hospital stay, and complications rates were compared between the two groups.

Results: Compared with Group B, Group A had a shorter operation time (145.5 ± 24.4 min vs. 169.0 ± 15.3 min, p = 0.0001), less intraoperative blood loss (75.3 ± 35.3 ml vs. 110.3 ± 50.6 ml, p = 0.0002), fewer conversions to laparotomy (2.4% vs. 16.7%, p = 0.023), fewer cases of postoperative pancreatic leakage (7.1% vs. 24.1%, p = 0.027), and fewer complications (23.8% vs. 53.7%, p = 0.003); all differences were significant. There was no statistically significant difference in the postoperative length of hospital stay, hospital cost, or rate of complications such as fever, postoperative abdominal infection, postoperative bleeding or venous thrombosis between the two groups.

Conclusion: For patients with traumatic splenic rupture, the right-lateral decubitus position is best for LS.

Key words: Laparoscopy, Traumatic splenic rupture, Splenectomy, Surgical position.

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