| Objective:This study compared the clinical data of totally laparoscopic splenectomy,hand-assisted laparoscopic splenectomy and open splenectomy for traumatic splenic rupture,and explored the safety and efficacy of three surgical methods for traumatic splenic rupture,In order to provide some references for the reasonable choice of surgical methods in clinical work.Methods:Retrospective analysis of the clinical data of 137 patients with traumatic splenic rupture who underwent surgery from October 2014 to December 2019 in the First Affiliated Hospital of Nanchang University was divided into three groups according to the different surgical methods,of which the totally laparoscopic group(TLS)Group 12 cases,hand-assisted laparoscopy group(HALS)36 cases,open surgery group(OS)89 cases,the general information,operation time,total blood loss,intraoperative blood transfusion,postoperative ventilation time,postoperative abdominal drainage volume,extraction time of abdominal drainage tube,the frequency of analgesics used after surgery,the length of hospital stay,the total cost of hospitalization,and the incidence of surgical complications.Results:All patients were successfully operated without any perioperative deaths None of the patients in the TLS group and HALS group were transferred to open surgery.(1)In the general data of the three groups,there was no statistically significant difference in age,gender,trauma cause,ASA score,preoperative hemoglobin and spleen injury level(P> 0.05).(2)Comparison of intraoperative data: In terms of operation time,the TLS group(159.17±39.88min)was longer than the HALS group(141.67±27.78min),the difference was statistically significant(P <0.05);compared with the TLS group andthe OS group The operation time was significantly prolonged(159.17±39.88 vs.126.74±28.79 min,P = 0.001);while the difference between the HALS group and OS group was not statistically significant.(3)Comparison of postoperative data:(1)In terms of postoperative abdominal drainage volume,TLS group(74.17±17.69ml)< HALS group(105.42±24.39ml)< OS group(150.03±40.55ml),and the difference between the three groups was statistically significant(P=0.000,P < 0.001).(2)In terms of the first ventilation time,the TLS group spent the least time,followed by the HALS group,and the OS group spent the longest time(2.33±0.49 vs2.92±0.65 vs 3.57±1.05 d,P=0.000,P < 0.001).(3)In terms of the removal time of postoperative drainage tube,the OS group(5.56±1.54d)was significantly longer than the TLS group(4.08±0.99d)and the HALS group(4.81 ± 1.33d),the difference was statistically significant(P < 0.01),while the difference between the TLS group and the HALS group was not statistically significant.(4)In terms of the number of postoperative analgesics used,the TLS group(5.83± 1.40 times)had a significant advantage over the OS group(8.11 ± 2.78 times)(P=0.007,P < 0.01),and the other pantwise comparisons showed no statistical significance.(4)Comparison of three groups of surgical methods for the treatment of spleen grade ? injury:(1)In terms of postoperative laparoscopic drainage,the TLS group(67.50 ±14.88ml)<HALS group(102.50 ± 22.21ml)<OS group(128.94 ± 33.97ml)the difference between the three groups was statistically significant(P = 0.000,P<0.001);(2)the postoperative ventilation time in the TLS group(2.25 ± 0.46d)was shorter than that in the HALS group(3.08±0.69d)and OS group(3.58±1.00d),the difference was statistically significant(P <0.05),the difference between HALS group and OS group was not statistically significant;(3)In the time of postoperative drainage tube removal,OS group(5.37±1.46d)was significantly longer than TLS group(4.00 ±1.07d)and HALS group(4.33 ±1.43d),the difference was statistically significant(P <0.05),while the difference between TLS group and HALS group was not statistically significant;(4)in terms of the number of postoperative analgesic drugs,TLS group(5.87±1.55)Compared with OS group(7.94±2.78),less analgesic drugs were used(P =0.035,P <0.05),and there was no statistically significant difference between the other two.(5)Comparison of the three groups of surgical methods for the treatment of splenic grade ? and ? injuries:(1)In terms of operation time,the TLS group(200.00 ± 23.09min)was significantly longer than the HALS group(135.00 ± 23.95min)and the OS group(133.62±29.13min),The difference was statistically significant(P <0.01),while the difference between the HALS group and the OS group was not statistically significant;(2)the three groups had postoperative abdominal drainage and postoperative first ventilation time(87.50±16.58 vs.106.87±25.74 vs.165.74±38.08 ml,P <0.01;2.50±0.57 vs.3.12±0.61 vs.3.61±1.09 d,P <0.05),the TLS group and the HALS group were better than the OS group,while the TLS group and the HALS group were not statistically different significance.Conclusion:1.TLS and HALS are safe,effective and feasible in the treatment of patients with traumatic splenic rupture.2.Compared with open surgery,laparoscopic technique has the advantages of wide surgical field,less damage and faster recovery in the treatment of patients with traumatic splenic rupture.3.Among the three surgical treatment methods for patients with hemodynamically stable spleen grade ? injury,TLS has a significant effect and has obvious advantages,which can be given priority.For patients with hemodynamically stable splenic grade III and IV injuries,HALS is a good alternative when TLS applications are limited. |
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