全腹腔镜与开腹门脉高压症巨脾切除加贲门周围血管离断术的临床对比研究  

Effect Comparison on Laparoscopic and Open Splenectomy in Giant Splenectomy Combined with Pericardia Vascular Disconnection for Portal Hypertension

作　　者：王文儿[1,2] 周旅[1,2] 宋新[1,2] 姚本能 周后平[1,2] 陈晓明[1,2] 付翔[1,2] 付华[1,2] 

机构地区：[1]湖南省湘西自治州人民医院 [2]吉首大学第一附属医院肝胆外科,吉首416000

出　　处：《中国现代手术学杂志》2015年第1期5-9,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨全腹腔镜下巨脾切除加贲门周围血管离断术治疗门脉高压症的安全性、可行性和手术技巧。方法回顾性分析我科2011年3月-2014年12月诊断为肝硬化门脉高压症并伴有脾功能亢进、食管胃底静脉曲张,需行巨脾切除加贲门周围血管离断术的57例患者的临床资料,分为全腹腔镜组（n=21）和开腹组（n=36）,分别行腹腔镜或开腹巨脾切除加贲门周围血管离断术。观察并比较两组患者术中、术后恢复情况及并发症发生情况。结果两组均顺利手完成手术。两组手术时间、术中失血量及术中输血率比较,均无统计学差异（P〉0.05）。与开腹组比较,全腹腔镜组术后止痛剂使用频次少,术后首次离床活动时间、术后恢复饮食时间、肛门恢复排气时间、腹腔引流管拔除时间早,术后住院日短,差异均有统计学意义（P〈0.05）。全腹腔镜组在术后发热、胸腔积液以及腹水发生方面均显著低于开腹组,差异有统计学意义（P〈0.05）,但在术后门静脉血栓形成、血小板计数显著升高、胰漏、切口感染以及胃排空障碍方面,组间比较差异无统计学意义（P〉0.05）。随访1个月-3.5年,各组病人一般情况均有所改善,无肝性脑病、未再发生呕血或黑便,未发生死亡病例。结论全腹腔镜巨脾切除加贲门周围血管离断术治疗肝硬化门脉高压症是安全、有效、可行的。Objective To discuss the safety,feasibility and surgical skills of total laparoscopic splenectomy for giant spleen resection and peri-cardia vascular disconnection in the portal hypertension cases. Methods A total of 52 cases diagnosed portal hypertension associated with hepatic cirrhosis,hypersplenia and esophagus-gastric fundus varicose vein,admitted from March 2011 to December 2014,were analyzed retrospectively. Among them,21 cases were performed laparoscopic splenectomy and peri-cardia vascular disconnection as laparoscopic group,and 36 cases were carried out open splenectomy and peri-cardia vascular disconnection as open group. The intra- and post-operative status and complications were observed and compared between two groups. Results All operations were accomplished in both groups. There was no statistic difference in operative duration,intra-operative blood loss and blood transfusion rate（ P 〉0. 05）. Compared to open group,the post-operative analgesics using,the time of ambulation,the time of postoperative recovery,the time of gastrointestinal recovery,the time of abdominal drainage extubation and post-operative hospital stays were short in laparoscopic group（ P〈0. 05）. The complication rate of postoperative fever,hydrothorax and ascites of laparoscopic group was lower than those of open group,and the difference was statistical（ P〈0. 05）. But no statistical difference was found in post-operative portal vein thrombosis,significant increasing of blood platelet count,pancreatic leakage,postoperative infection and gastric emptying disability between two groups（ P〉0. 05）. Conclusion The surgical intervention of laparoscopic splenectomy combined with peri-cardia vascular disconnection is safe,feasible and effective for portal hypertension due to hepatic cirrhosis.

关 键 词：脾切除术 腹腔镜检查 高血压 门静脉 贲门周围血管离断术 

分 类 号：R657.6[医药卫生—外科学]