Analysis Of The Operative Effect Of 71 Cases Of Traumatic Rupture Of Spleen

Objective:To analyze the effect of different surgical methods on traumatic splenic rupture.Method:From August 2015 to August 2019,a total of 71 patients with traumatic splenic rupture who were treated in Tianjin Third Center Hospital and selected from all splenic rupture patients were retrospectively analyzed.The general postoperative conditions,complications,immune function and psychological and emotional status of patients in each group were compared.Result:These 71 cases included patients at all levels of I,II,III,and IV.Among all,13 patients of Level I accounted 18.31%,23 patients of Level II accounted32.39%,18 patients of Level III accounted 25.35%and 17 patients of Level IV accounted 23.94%.The surgery treatment cases including 4 cases of laparotomy operation,12 cases of spleen repair,15 cases of partial splenectomy,11 cases of spleen autotransplantation after splenectomy,23 cases of open splenectomy(OS),and 10 cases of laparoscopic splenectomy(LS).The value of operation time(140.67±38.76)min,blood transfusion(418.36±38.92)ml and duration of hospitalization(14.47±3.68)d of the spleen repair group were significantly lower than those of non-laparoscopic surgery group;the partial splenectomy group had the longest operation time(220.87±41.26)min,while the amount of blood transfusion(445.47±39.42)ml and duration of hospitalization(16.32±4.12)d showed no significant difference compared to other laparotomy operation groups;the value of operation time(110.45±38.45)min,blood transfusion(400.13±36.74)ml and duration of hospitalization(12.14±2.89)d of LS group were remarkably lower than those of other laparotomy groups;the lowest complication rate was in spleen repair group,followed by the laparoscopic splenectomy group and the rest laparotomy operation groups showed no obvious difference.All patients were cured and discharged without death.30 days after surgery,the levels of CD3~+,CD4~+,CD4~+/CD8~+T lymphocytes in each group were significantly higher than those at 15 days after surgery in this group,P<0.05;while CD8+T lymphocyte level did not have a noticeable change,P>0.05;the levels of CD3~+,CD4~+,CD4~+/CD8~+T lymphocytes in spleen repair group at 15 days and 30 days after surgery were higher than the other four groups,P<0.05;the levels of CD3~+,CD4~+,CD4~+/CD8~+T lymphocytes in the partial splenectomy group were higher at 15 days and 30 days after surgery than that of spleen autotransplantation after splenectomy,OS,and LS;the level of lymphocytes in spleen autotransplantation after splenectomy was slightly higher than that in OS and LS groups,but the difference was not statistically significant,P>0.05;the levels of CD3~+,CD4~+,CD4~+/CD8~+T lymphocytes in OS and LS groups were not significantly changed after 15 days and 30 days after surgery,P>0.05.The SAS score(46.57±2.63)and SDS score(45.11±2.74)of LS group were much lower than those laparotomy groups,P>0.05,and there was no significant difference among laparotomy groups.The spleen repair surgery has the least complications and the spleen function is preserved to the greatest extent;the partial spleen resection partially retains the spleen function.The postoperative complications and the duration of hospitalization have no significant difference from the non-LS groups,which is beneficial to the rapid recovery of the patient’s immune function after surgery.Meanwhile,such operation is of high degree of difficulty and the operation time is long;spleen autotransplantation after splenectomy can retain part of the spleen function and has rapid hemostasis,but it may fail to achieve the purpose of retaining part of the spleen function for the insufficient spleen transplanted;OS treatment is widely accepted to achieve rapid hemostasis and is suitable for patients with comminuted splenic rupture or older patients who are unable to accept long-term surgery;LS treatment for traumatic splenic rupture features less trauma,less bleeding,good prognosis and high safety.But it sets strict requirements for doctors and it is possible to transfer to OS,and the function of spleen cannot be retained.Conclusion:Different surgical methods have their own advantages and disadvantages.A reasonable surgical method should be applied according to the type of splenic injury of the patient.On the premise of saving lives,the spleen function should be retained as much as possible.