全腹腔镜脾切除联合经内镜食管曲张静脉套扎术与开腹断流术治疗门静脉高压症的临床对照研究  

The effect of total laparoscopic splenectomy combined with endoscopic variceal ligation on portal hypertension in hepatitis B cirrhosis patients

作　　者：张宇[1] 杨洪吉[1] 邓小凡[1] 朱世凯[1] 陈凯[1] 陈云飞[1] 赵冀[1] 刘兴超[1] 

机构地区：[1]四川省医学科学院.四川省人民医院器官移植中心,四川成都610072

出　　处：《实用医院临床杂志》2013年第2期43-47,共5页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:110166)

摘　　要：目的探讨全腹腔镜脾切除联合经内镜食管曲张静脉套扎术治疗乙肝后肝硬化门静脉高压症的临床疗效。方法收集2008年7月至2012年7月因乙肝后肝硬化门静脉高压症在我院治疗的60例患者,其中全腹腔镜脾切除联合经内镜食管曲张静脉套扎术28例(腔镜套扎组)以及同期行开腹脾切除联合贲门周围血管离断术的30例(传统开腹组),比较两组的平均手术时间、术中出血量、术后血浆引流量、术后肛门排气时间以及手术并发症等临床安全性相关指标的变化;研究两组患者炎症因子C-反应蛋白(C-reactive protein,CRP)、门静脉血流动力学、肝脏储备功能、食管曲张静脉复发、上消化道再出血、门静脉高压性胃病分级等临床疗效相关指标的变化。结果腔镜套扎组的住院费用与传统开腹组比较差异无统计学意义(P>0.05);平均手术时间、术中出血量、术后血浆管引流量、术后肛门排气时间、术后住院时间明显少于传统开腹组(P<0.05);腹水、胸腔积液等术后并发症的发生率明显低于传统开腹组(P<0.05);术后肝脏血流动力学差异无统计学意义(P>0.05);腔镜套扎组术后第1、3天的CRP低于传统开腹组(P<0.05)。术后均随访12个月,两组术后肝脏功能的MELD及Child评分、上消化道再出血率、重度食管胃底静脉曲张、门静脉高压性胃病的分级差异均无统计学意义(P>0.05)。结论全腹腔镜脾切除联合经内镜食管曲张静脉套扎术能够有效地治疗乙肝后肝硬化门静脉高压症,创伤小,恢复快,并发症少,能有效减少门静脉血流量,食管曲张静脉复发率及出血率。Objective To investigate the effect and safety of total laparoscopic splenectomy combined with endoscopic variceal ligation on portal hypertension in hepatitis B cirrhosis patients. Methods Between January 2008 and April 2012,58 patients with por- tal hypertension caused by hepatitis B cirrhosis were studied retrospectively. Of the patients, 28 patients were undergone total laparo- scopic splenectomy with endoscopic variceal ligation （ Laparoscopic Ligation Group） and 30 patients were undergone traditional open splenectomy with pericardial devascularization（Traditional Open Group）. The clinical safety related indicators including mean operative time, intraoperative blood loss, postoperative plasma drainage volume, postoperative anal exsufflation time and postoperative complica- tions were recorded. The clinical efficacy related indicators including inflammatory factors C-reactive protein, portal hemodynamics, liver function, the recurrence of esophageal varices and upper gastrointestinal bleeding and portal hypertension gastropathy classification were studied. Results There was no significant difference between the two groups in hospitalization costs. However, there were significant differences in the mean operative time, intraoperative blood loss, postoperative plasma drainage volume, postoperative plasma drainage volume, postoperative hospital stay between the two groups （P 〈 0. 05 ）. The postoperative complications such as ascites and pleural ef- fusion were decreased significantly in the laparoscopic ligation group compared with the traditional open group （ P 〈 0. 05 ）. The CRP levels on POD1 and POD3 after operation were higher than that before perative in both two groups（P 〈 0. 05 ） ,but the CRP levels in the laparoscopic ligation group were lower significantly than that in the traditional open group（ P 〈 0.05 ）. There was no significant differ- ence in the white blood cell counts,the platelet counts,the hepatic artery diameter, hepatic artery RI and portal vein flow volume o

关 键 词：腹腔镜脾切除 胃镜套扎 门静脉高压 断流术 

分 类 号：R657.34[医药卫生—外科学] R656[医药卫生—临床医学]