计算机断层扫描血管成像在二级脾蒂离断法行腹腔镜脾切除术中的临床价值

Clinical value of CT angiography in laparoscopic splenectomy with amputation of secondary structures of the spleen pedicel

摘要:

目的：探讨计算机断层扫描血管成像（computed tomography angiography，CTA）对应用二级脾蒂离断法行腹腔镜脾切除术（laparoscopic splenectomy，LS）的临床价值。方法：收集62例特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）患者的临床资料进行回顾性分析，比较术前行CTA检查（CTA组）与未行CTA检查行LS（对照组）的两组病例资料。结果：两组手术时间分别为（185.58±14.09） min和（215.00±22.01） min，两组术中出血分别为（165.78±88.42） ml和（262.78±80.70） ml，两组住院时间分别为（8.46±1.48） d和（10.14±1.51） d，以上各组差异有统计学意义（P<0.05）。结论：CTA组术前能掌握脾脏血管的解剖及其与胰腺的关系，指导术中精细解剖脾脏血管，采用Hem-O-lok结扎、超声刀离断脾蒂血管，免用Endo-GIA，较对照组手术时间短、术中出血少、住院时间短。本研究认为CTA检查对ITP需行LS治疗的患者具有临床价值。

Abstract:

Objective：To investigate the practical value of CT angiography（CTA） in laparoscopic splenectomy（LS） with amputation of secondary structures of the spleen peclicel. Methods：Clinical records of 62 patients with idiopathic thrombocytopenic purpura（ITP） were retrospectively analyzed. Clinical data of patients underwent CTA scan（CTA group） and those did not underwent CTA scan but did LS（control group） were compared. Results：Operative time was （185.58±14.09） min and （215.00±22.01） min in CTA group and control group，Intraoperative blood loss was （165.78±88.42） ml and （262.78±80.70） ml，postoperative hospital stay was （8.46±1.48） d and （10.14±1.51） d，with statistical significances（P<0.05）. Conclusions：Anatomical structure of spleen blood ves－sels and their relationship with pancreas can be mastered before surgery in CTA group，which can guide better dissection of spleen blood vessels in surgery and also contribute to Hem-O-lok ligation and cut off of the blood vessels using harmonic scalpel rather than using Endo-GIA. CTA group displays shorter operative time，less bleeding and shorter hospital stay than control group. Therefore，CTA scan is of clinical valuable for ITP patients who need the treatment of LS.