改良腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的临床疗效  

Comparison of modified laparoscopic and open splenectomy and pericardial devascularization for the treatment of cirrhotic portal hypertension

作　　者：蒋国庆 钱建军 陈平 姚捷 陶永忠 金圣杰 王小东 柏斗胜 

机构地区：[1]扬州大学临床医学院肝胆外科,225001

出　　处：《中华消化外科杂志》2013年第11期846-849,共4页Chinese Journal of Digestive Surgery

基　　金：江苏省自然科学基金（BK2010300）

摘　　要：目的探讨改良腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的安全性及其近期疗效。方法回顾性分析2010年1月至2013年2月扬州大学临床医学院收治的107例肝硬化门静脉高压症患者的临床资料。接受改良腹腔镜脾切除联合贲门周围血管离断术患者为改良腹腔镜组（37例），开腹脾切除联合贲门周围血管离断术为开腹组（70例），比较两组患者术中和术后情况。计量资料采用t检验或Mann—WhitneyU检验，计数资料采用，检验。结果改良腹腔镜组患者的中位手术时间为210min（185～245min），明显长于开腹组的175min（150～190min），两组比较，差异有统计学意义（Z=-4．624，P〈0．05）。改良腹腔镜组患者中位术中出血量为150ml（100～200m1）、术后第1天疼痛指数为2．5±0．9、术后进食欲望时间为（1．5±0．7）d、术后肛门排气时间为（2．4±1．0）d、术后下床活动时间为（2．7±0．7）d、术后住院时间为（10．5±2．2）d，均显著低于开腹组的300ml（188～400m1）、5．1±1．1、（2．8±0．6）d、（3．2±1．0）d、（5．9±0．9）d、（15．7±4．3）d，两组比较，差异有统计学意义（Z=-3．570，t=-12．546，-9．834，-3．635，-18．780，-8．350，P〈0．05）。改良腹腔镜组5例患者术后发生并发症，显著少于开腹组的25例（X2=5．913，P〈0．05）。结论改良腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症安全可行且疗效确切，其近期疗效明显优于开腹手术。Objective To investigate the safety and short-term efficacy of modified laparoscopic and open splenectomy and pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods The clinical data of 107 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University from January 2010 to February 2013 were retrospectively analyzed. Patients were divided into the modified laparoscopic group （37 patients ） and the open group （70 patients ）. The intra- and postoperative condition of the patients of the 2 groups were compared. The measurement data were analyzed using the t test or Mann-Whitney U test, and the enumeration data were analyzed using the chi-square test. Results The median operation time of the modified laparoseopic group was 210 minutes （range, 185-245 minutes） , which was longer than 175 minutes of the open group （range, 150-190 minutes） , with significant difference between the 2 groups （ Z = - 4. 624, P 〈 0.05 ）. The median volume of intra-operative blood loss, pain rating index of the first day after operation, first appetite time after operation, initial passage of flatus time, postoperative off-bed activity time and duration of postoperative hospital stay were 150 ml （range, 100-200 ml） , 2.5 ± 0.9, （l. 5 ± 0.7）days, （2.4 ± 1.0） days, （2.7 ± 0.7 ） days, （ 10.5 ± 2.2 ） days in the modified laparoscopic group, and 300 ml （ range, 188- 400 ml）, 5.1 ±1. 1, （2.8 ±0.6）days, （3.2 ± 1.0）days, （5.9 ±0.9）days and （15.7 ±4.3）days in the open group, with significant difference between the 2 groups （Z = -3.570, t = - 12. 546, -9. 834, -3. 635, - 18. 780, - 8. 350, P 〈 0.05 ）. The number of patients who had postoperative complications in the modified laparoscopicgroup was 5, which was significantly smaller than 25 in the open group （X2 = 5. 913, P 〈 0.05）. Conclusions The procedure of modified laparoscopic splenectomy and pericardial devascularization for

关 键 词：门静脉高压症 腹腔镜检查 脾切除术 贲门周围血管离断术 

分 类 号：R657.3[医药卫生—外科学]