改良腹腔镜脾切除联合断流术在门脉高压症老年患者中的应用  

Modified laparoscopic splenectomy and pericardial devascularization for the aged patients with portal hypertension

作　　者：蒋国庆 陈平 钱建军 姚捷 陶永忠 王小东 金圣杰 柏斗胜 

机构地区：[1]扬州大学临床医学院肝胆外科,225001

出　　处：《中华肝胆外科杂志》2014年第3期205-207,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：江苏省自然科学基金（BK2010300）;扬州市医学重点人才基金

摘　　要：目的探讨改良腹腔镜下脾切除联合贲门周围血管离断术与开腹手术治疗肝硬化性门静脉高压症老年患者的安全性及临床价值。方法回顾性分析42例老年患者的临床资料。根据手术方式的不同分为两组，其中接受改良腹腔镜下脾切除联合贲门周围血管离断术的为腹腔镜组（20例），施行开腹的为开腹组（22例），比较两组患者术中和术后的情况。结果除了腹腔镜组患者的手术时间明显长于开腹组外（P〈0．05），腹腔镜组患者术中出血量、术后第1天的疼痛指数、术后进食欲望时间、术后肛门排气时间、术后下床活动时间、术后住院天数及并发症，均显著低于开腹组。同时，腹腔镜组的术后发热天数和人数、术后第1天和第7天的白细胞计数、术后第3天和第7天的天冬氨酸转氨酶（AST）水平、及术后第7天丙氨酸转氨酶（ALT）水平均显著低于开腹组。结论改良腹腔镜脾切除联合贲门周围血管流断术治疗肝硬化性门静脉高压症老年患者是安全可行且疗效确切的，其近期疗效明显优于开腹手术，值得临床推广。Objective To investigate and compare the safety and efficacy of pericardial devascularization combined with either modified laparoscopic or open splenectomy for cirrhotic and aged patients with bleeding varices due to portal hypertension and secondary hypersplenism. Methods 139 cirrhotic patients with bleeding varices due to portal hypertension and secondary hypersplenism were treated at the Clinical Medical College of Yangzhou University. A retrospective study was conducted on the patients （ n = 42） who received pericardial devascularization combined with either modified laparoscopic or open splenectomy between January 2011 and October 2013. These patients were divided into the laparoscopic group （LAP, n = 20） and the open group （OPEN, n = 22）. The peri-operative clinical parameters were analyzed and were compared. Results When compared to the OPEN group, the operative time in the LAP group was longer （P 〈 0.05）. However, the amount of intraoperative bleeding, pain score on the first day after operation, time to the first meal after operation, time to first passage of flatus, time to first off-bed activity, postoperative hospital stay and complications in the LAP group were all less than the OPEN group （ all P 〈 0. 05 ）. Furthermore, the postoperative body temperature, white blood cell counts （ days 1 and 3）, AST （ days 3 and 7） and ALT （days 7） concentrations in the LAP group were significantly better than the OPEN group. Conclusions Modified laparoscopic splenectomy and pericardial devascularization for the aged was safe, feasible and with good therapeutic effect. It had better short-term clinical effect than that of open surgery.

关 键 词：老年患者 高压症 门静脉 腹腔镜检查 脾切除术 断流术 

分 类 号：R657.3[医药卫生—外科学]