腹腔镜下次全脾切除术治疗肝硬化门脉高压症继发性脾功能亢进的近期疗效  

Short-term efficacy of laparoscopic subtotal splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

作　　者：陈浩琦 王小文 李洋[1] 余振宇 朱文峰 吕韵 朱曙光[1] 叶林森[1] 陈规划[1] 汪根树[1] CHEN Hao⁃qi;WANG Xiao⁃wen;LI Yang;YU Zhen⁃yu;ZHU Wen⁃feng;LÜ Yun;ZHU Shu⁃guang;YE Lin⁃sen;CHEN Gui⁃hua;WANG Gen⁃shu(Department of Hepatic Surgery,Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat⁃sen University,Guangzhou,Guangdong 510630,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心,广东广州510630

出　　处：《热带医学杂志》2022年第4期483-489,共7页Journal of Tropical Medicine

基　　金：国家自然科学基金(81870447,82070673)

摘　　要：目的评价腹腔镜次全脾切除术治疗肝硬化门脉高压症继发性脾功能亢进(脾亢)的安全性和近期疗效。方法收集中山大学附属第三医院2018年7月-2021年11月75例腹腔镜脾切除术治疗肝硬化门脉高压症继发性脾亢病人的临床资料,其中腹腔镜次全脾切除术(LSS)9例,采用倾向性匹配方法按1∶1匹配选取9例腹腔镜全脾切除术(LTS)9例,比较二者的近期疗效。结果LSS和LTS两组患者均顺利完成手术。两组术后第7天白细胞和血小板计数与术前相比均升高(LSS组:t_(白细胞)=-6.72,t_(血小板)=-8.59;LTS组:t_(白细胞)=-10.00,t_(血小板)=-24.63,P均<0.05),且LSS组均低于LTS组(t_(白细胞)=-2.26,t_(血小板)=-3.71,P均<0.05)。LSS组术后第7天外周血CD4+/CD8+比值升高(t=-0.95,P>0.05),LTS组术后第7天外周血CD4+/CD8+比值降低(t=2.64,P<0.05),LSS组明显高于LTS组(t=3.34,P<0.05);LSS组术后第7天血清IgM降低(t=1.54,P>0.05),促吞噬肽升高(t=-0.23,P>0.05),但差异无统计学意义;LTS组术后第7天血清IgM和促吞噬肽降低(t_(IgM)=4.89,t_(促吞噬肽)=2.59,P均<0.05),LSS组术后第7天血清IgM和促吞噬肽高于LTS组(t_(IgM)=3.89,t_(促吞噬肽)=2.57,P均<0.05)。结论LSS治疗肝硬化门脉高压症继发性脾亢安全有效,近期疗效优于LTS。Objective To evaluate the safety and short-term efficacy of laparoscopic subtotal splenectomy(LSS)for hypersplenism secondary to liver cirrhosis and portal hypertension.Methods The clinical data of 75 patients with hypersplenism secondary to liver cirrhosis and portal hypertension in our hospital from July 2018 to November 2021 were collected.LSS was performed in 9 patients.Using a propensity score matching(PSM)method,9 matched controls were selected from patients with laparoscopic total splenectomy(LTS).The short-term efficacies of the two groups were compared.Results LSS or LTS were successfully completed for all patients in both groups.The postoperative counts of white blood cell(WBC)and platelets in both groups were significantly increased compared to the preoperative ones(P<0.05).On postoperative day(POD)7,the counts of WBC and platelets were significantly lower in LSS group than that in LTS group(P<0.05).Postoperative CD4^(+)/CD8^(+)ratio in LSS group was increased(P>0.05),while that in LTS group was significantly decreased(P<0.05).The ratio of CD4^(+)/CD8^(+)was significantly higher in LSS group than that in LTS group on POD7(P<0.05).Postoperative serum immunoglobulin(Ig)M and Tuftsin in both groups were decreased on POD7(P value of LSS group>0.05while that of LTS group<0.05).The serum IgM and Tuftsin were significantly higher in LSS group than those in LTS group on POD7(P value all<0.05).Conclusions LSS is a safe and effective surgical method for the treatment of hypersplenism secondary to liver cirrhosis and portal hypertension.Its short-term efficacy is more favorable compared with LTS.

关 键 词：全脾切除术 次全脾切除术 腹腔镜 肝硬化 门静脉高压 脾功能亢进 

分 类 号：R657.6[医药卫生—外科学] R575.2[医药卫生—临床医学]