改良腹腔镜脾切除联合贲门周围血管离断术治疗门脉高压症的学习曲线  

The learning curve of modified laparoscopic splenectomy plus pericardial devascularization in the treatment of portal hypertension

作　　者：蒋国庆 钱建军 陈平 姚捷 金圣杰 王小东 高志慧 柏斗胜 

机构地区：[1]扬州大学临床医学院肝胆外科,扬州225001

出　　处：《中华肝胆外科杂志》2014年第9期652-654,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：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 探讨改良腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化性门静脉高压症的学习曲线.方法 回顾性分析2012年2月至2013年8月由我科同一团队完成的60例改良腹腔镜脾切除联合贲门周围血管离断术.按手术先后顺序,每组10例设定为一手术阶段,依次分为6组（A-F）,比较各组间患者术中和术后情况.结果 术前各组患者在性别、年龄、肝功能Child-pugh分级和脾长径方面差异无统计学意义（P＞0.05）.A和B组手术时间明显长于其他各组（P＜0.05）,且A和B组旋（切）脾时间明显长于其他各组（P＜0.05）.各组间术中出血量、术中输血量、进食欲望时间、术后第一天疼痛指数、肛门排气时间、术后住院时间、术后并发症发生率及中转开腹率均无统计学差异（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性门脉高压症,经过20例左右手术可达到较熟练和稳定的程度.Objective To study the learning curve of modified laparoscopic and open splenectomy plus pericardial devascualrization in the treatment of portal hypertension.Methods From February 2012 to August 2013,60 patients underwent modified laparoscopic splenectomy and azygoportal disconnection by the same surgical team in our department.The data of these patients was retrospectively analyzed.Using the dates of surgery,these patients were equally divided into groups A,B,C,D,E and F with 10 patients in each group.The demographic,intraoperative and postoperative variables of the patients were compared among the six groups.Results There were no significant differences in sex,age,Child-Pugh classification and longitudinal diameter of spleen among the six groups （P 〉 0.05）.The operative time in groups A and B were significantly longer than the other groups,respectively （P 〈 0.05）.Similarly,the spleen removal time in groups A and B were also significantly longer than the other groups,respectively （P 〈 0.05）.There were no significant differences in intraoperative blood loss,intraoperative blood transfusion,Visual Analogue Scale （VAS） pain score on the first day after surgery,times to first oral intake/first passage of flatus,postoperative hospital stay,perioperative complications and the rate of conversion into open operation among the six groups （P 〉 0.05）.Conclusion A surgeon was over his learning curve in modified laparoscopic and open splenectomy and azygoportal disconnection by operating on 20 liver cirrhotic patients with portal hypertension.

关 键 词：门静脉高压症 腹腔镜检查 脾切除术 断流术 学习曲线 

分 类 号：R657.6[医药卫生—外科学]