目的

分析腹腔镜微创纱垫取出术与传统小切口开腹纱垫取出术在高原地区肝破裂二期手术中应用效果。

方法

选取2017年1月至2022年12月一期行单纯开腹肝周纱垫填塞法止血治疗的创伤性肝脏破裂患者60例，采用随机数字表法随机分为两组，每组患者各30例。对照组行二期传统小切口开腹肝周纱垫取出术，观察组行二期腹腔镜肝周纱垫取出术。采用统计学软件SPSS 23.0分析数据。计数资料以［例（%）］表示，组间比较采用χ²检验；等级计数资料比较采用秩和检验；符合正态分布的计量资料以（± s）表示，组间比较采用独立样本t检验。P＜0.05表示差异具有统计学意义。

结果

观察组患者手术时间长于对照组，手术出血量、腹壁切口大小、术后住院时间、住院费用及术后1d、3d VAS评分均优于对照组，差异均具有统计学意义（P＜0.05）；与术前比较，两组患者术后白细胞计数（WBC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）水平均升高，且对照组显著高于观察组，差异有统计学意义（P＜0.05）；观察组患者术后并发症总发生率为10.0%，显著低于对照组的33.3%，差异具有统计学意义（P＜0.05）。

结论

高原地区肝破裂患者二期行腹腔镜纱垫取出术，相比传统小切口开腹手术虽延长了手术时间，但具有出血少、切口小、疼痛轻等微创优势，同时可减轻术后炎症反应，降低并发症发生率，更利于患者术后恢复，具有较高的经济效益和应用价值，值得在临床推广。

Objective

To analyze the effect of minimally invasive laparoscopy and traditional small incision in the second stage of liver rupture in high altitude area.

Methods

A total of 60 patients with traumatic liver rupture who received simple perihepatic gauze packing for hemostasis from January 2017 to December 2022 were selected and divided into two groups by random number table method, with 30 patients in each group.The control group underwent two stage traditional small incision operation and the observation group underwent two stage laparoscopic operation.Statistical software SPSS 23.0 was used to analyze the data.The counting data were presented as［ cases (%)］, and the comparison between groups was performed by χ² test.Rank Sum test was used to compare rank count data.The measurement data conforming to the normal distribution were represented by (± s ), and the independent sample t test was used for comparison between groups.P＜0.05 indicated that the difference was statistically significant.

Results

The operation time of observation group was longer than that of control group, and the amount of blood loss, abdominal incision size, postoperative hospitalization time,hospitalization cost and postoperative 1d and 3d VAS scores were all better than those of control group, with statistical significance (P＜0.05).Compared with preoperative, postoperative WBC, CRP and IL-6 levels in 2 groups were increased, and control group was significantly higher than observation group, the difference was statistically significant (P＜0.05).The total incidence of postoperative complications in the observation group was 10.0%, significantly lower than that in the control group (33.3%), and the difference was statistically significant (P＜0.05).

Conclusion

Compared with traditional small-incision open surgery, laparoscopic gauze pad extraction in the second stage for patients with liver rupture in plateau areas can prolong the operation time, but it has the advantages of less bleeding, small incision and light pain.At the same time, it can reduce postoperative inflammation, reduce the incidence of complications, and is more conducive to postoperative recovery of patients.It has high economic benefits and application value, and is worthy of clinical promotion.