金手指在改良腹腔镜下脾切除联合贲门周围血管离断术中的巧用  

Use of goldfinger during modifed laparoscopic splenectomy and pericardial devascularization

作　　者：蒋国庆 陈平 钱建军 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：《国际外科学杂志》2014年第11期740-743,F0003,共5页International Journal of Surgery

基　　金：江苏省自然科学基金（No.BK2010300）

摘　　要：目的探讨金手指应用在改良的腹腔镜下睥切除联合贲门周围血管断流术中的安全性及可行性。方法回顾性分析2010年1月-2014年1月扬州大学临床医学院肝胆外科收治的148例肝硬化性门脉高压患者的临床资料。根据其接受不同的手术方式分为两组，其中接受改良的腹腔镜下脾切除联合贲门周围血管断流术的为改良腹腔镜组（77例），开腹脾切除联合贲门周围血管断流术为开腹组（71例），比较两组患者术中和术后情况。结果改良腹腔镜组患者的中位手术时间明显长于开腹组[（212．9±48．4）minvs（175．1±33．6）min，P〈0．05]。改良腹腔镜组患者术中出血量、术中输血量、术后住院天数为均显著低于开腹组[分别为（173．6±187．8）mlvs（326．8±244．2）mL、（11．7±72．5）mLvs（71．8±176．6）mL、（10．5±2．1）dvs（15．8±4．2）d，P〈0．05）]。改良腹腔镜组7例患者术后发生并发症，显著低于开腹组组的25例（P〈0．05）。结论金手指应用在改良的腹腔镜下脾切除联合贲门周围血管断流术是安全且可行的，值得临床推广。Objective To investigate the safety and feasibility of clinical application of of goldfinger during modified laparoscopic splenectomy and pericardial devascularization. Methods A total of 148 patients with cirrhotic portal hypertension and secondary hypersplenism was admitted to Clinical Medical College of Yang- zhou University, who undergoing modified laparoscopic or open splenectomy and pericardial devaseularization between January 2011 and January 2014 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group （LAP, n = 77 ） and open group （OPEN, n = 71 ）. Peri-operative clinical parameters were analyzed were compared between the two groups. Results Compared to the OPEN group, operative time in the LAP group was longer [ （212.9 ± 48.4） rain vs （175.1 ± 33.6） rain, P 〈 0.05 ], but volume of intraoperative bleeding, volume of intraoperative blood transfusion, and postoperative hospital stay in the LAP group were all less than those in the OPEN group [ the date respectively was （ 173.6 ± 187.8 ） mL vs （326.8 ± 244.2） mL, （ 11.7 ± 72.5 ） mL vs （71.8 ± 176.6） mL, （ 10.5 ± 2.1 ） d vs （ 15.8 ± 4.2） d, P 〈 0.05 ] , and complications in the LAP group （7 complications） and the OPEN group （25 complications） had taken place postoperatively, there was significant difference in complications between the two groups （7/77 vs 25/71, P 〈 0. 05 ）. Conclusion The application of of goldfinger during modified ]aparoscopic spleneetomy and pericardial devas- cularization for portal hypertension is safe and feasible. It is worth generalizing.

关 键 词：高血压 门静脉 腹腔镜检查 脾切除术 贲门周围血管离断术 金手指 

分 类 号：R657.3[医药卫生—外科学]