腹腔镜脾切除联合断流术治疗门静脉高压症  

Laparoscopic versus open splenectomy plus pericardial devascularization for portal hypertension

作　　者：董瑞[1] 杜锡林[1] 王青[1] 阴继凯[1] 赵磊[1] 李江斌[1] 樊东[1] 陈安[1] 张章[1] 鲁建国[1] 

机构地区：[1]第四军医大学唐都医院普通外科,西安710038

出　　处：《中华普通外科杂志》2014年第2期105-107,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨腹腔镜脾切除联合断流术治疗门静脉高压症的方法及安全性.方法 选择第四军医大学唐都医院201 1年6月至2012年12月开展的腹腔镜脾切除联合贲门周围血管离断术与传统开腹手术患者的临床资料,其中腹腔镜组115例,开腹手术组50例,比较两组患者手术安全性及围手术期疗效.结果 腹腔镜组手术时间[（196 ±24） min]与开腹组手术时间[（160±34） min]相比差异无统计学意义（t=0.475,P=0.492）.腹腔镜组术中出血量[（346±112） ml]、术后发热时间[（3.8±2.0） d]均少于开腹组[（506±167） ml、（6.6±2.7）d]（t=7.449、5.806,P =0.007、0.017）.腹腔镜组术后腹腔引流管拔出时间[（4.1±0.7）d]及术后住院时间[（6.3±0.6）d]均短于开腹组[（6.3±0.6）d、（8.4±0.8）d]（=7.456、5.371,P=0.007、0.022）.腹腔镜组手术后并发症发生率（4.5％）较开腹组（16.0％）低（P =0.025）.结论 腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症具有创伤小、出血少、术后恢复快等优点.Objective To evaluate clinical efficacy of laparoscopic splenectomy plus pericardial devascularization for portal hypertension.Methods The clinical data of laparoscopic operation and open operation between June.2011 and Dec.2012 were analyzed.115 patients of portal hypertension underwent laparoscopic splenectomy combined with pericardial devascularization and 50 patients underwent traditional open operation.We compare the safety and clinical results of the two procedures.Results The operation time in laparoscopy group,（196 ± 24） min,was longer than that of the traditional open operation group,（160 ± 34） min,（t =0.475,P =0.492）.The mean blood loss,fever duration after operation were （346 ± 112） ml,and （3.8 ± 2.0） d,which were less than that of the traditional group（t =7.449,5.806,P =0.007,0.017）.The mean time of intraperitoneal dranage and postoperative hospital stay were （4.1 ± 0.7） d and （6.3 ± 0.6） d respectively,which were shorter than that of the traditional group （t =7.456,5.371,P =0.007,0.022）.The postoperative complications of the laparoscopy group（4.5%） is lower than that （16.0%） of the traditional group （P =0.025）.Conclusions Laparoscopic splenectomy combined with pericardial devascularization for portal hypertension is a safe procedure,reducing the operation trauma and blood loss,improving postoperative recovery.

关 键 词：高血压 门静脉 脾切除术 腹腔镜 贲门周围血管离断术 

分 类 号：R657.3[医药卫生—外科学]