腹腔镜选择性门奇静脉断流术治疗门静脉高压症疗效分析  

Effects of laparoscopic selective portoazygous devascularization for portal hypertension

作　　者：马洋[1,2] 孙星 

机构地区：[1]上海交通大学附属第一人民医院普外科,上海200080 [2]上海交通大学医学院,上海200025

出　　处：《外科理论与实践》2017年第6期504-508,共5页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(81270556)

摘　　要：目的:探讨腹腔镜脾切除及选择性门奇静脉断流术(LSSD)治疗门静脉高压症的安全性与疗效。方法:回顾性分析2012年1月至2014年12月我院127例门静脉高压症病人手术治疗的临床资料。其中行LSSD 55例,行开腹脾切除及非选择性门奇静脉断流术(OSSD)72例。分析两组围手术期和术后随访资料。结果:LSSD组术中出血量[(243.9±25.1)mL]、术后并发症发生率(30.9%)及术后住院时间[(9.5±1.9)d]显著低于OSSD组[(335.9±40.2)mL、51.4%、(14.2±2.4)d](P<0.05),但LSSD组手术时间比OSSD组明显长[(230.9±24.9)min比(202.5±30.3)min,P<0.001)]。术后1年随访显示LSSD组无上消化道再出血,显著低于OSSD组(9.7%)(P<0.05)。LSSD组重度食管静脉曲张病人比例(9.1%)、肝功能Child-Pugh评分(7.7±2.0)、门静脉内径[(14.3±0.6)mm]均显著低于OSSD组[23.6%、8.5±2.0、(14.5±0.5)mm](P<0.05)。门静脉系统血栓发生率LSSD组(16.4%)与OSSD组(29.2%)无统计学差异(P>0.05)。结论:LSSD创伤小、效果佳,是治疗门静脉高压症的理想手术方式。Objective To evaluate the safety and effects of laparoscopic splenectomy plus selective portoazygous devascularizationin（LSSD） for the patients with portal hypertension. Methods From January 2012 to December 2014, the clinical data of 127 patients with portal hypertension in our hospital were studied retrospectively. LSSD was performed in55 patients, and open splenectomy and non-selective portoazygous devascularization（OSSD） in 72 patients. The clinical perioperative data were analyzed. The patients were followed up for one year after LSSD and OSSD. The data on portal hypertension were analyzed including upper gastrointestinal bleeding, the grade of esophageal varices, Child-Pugh score,the diameter of portal vein and portal vein thrombosis. Results Intraoperative blood loss [（243.9±25.1） mL vs（335.9±40.2）mL], postoperative complications（30.9% vs 51.4%） and hospital stay [（9.5 ±1.9） d vs（14.2±2.4） d] were significantly less in the patients of LSSD group than in the patients of OSSD group（all P〈0.05）. However, operation time was significantly longer in LSSD group [（230.9±24.9） min vs（202.5±30.3） min]（P0.001） than in OSSD group. Follow-up after one year of operation showed no upper gastrointestinal rebleeding in LSSD group and 9.7% in OSSD group（ P〈0.05）. The patients with severe grade of esophageal varices（9.1% vs 23.6%）, Child-Pugh scores [（7.7±2.0） vs（8.5±2.0）] and the diameter of portal vein [（14.3±0.6） mm vs（14.5±0.5） mm] were significantly lower in LSSD group than in OSSD group（all P〈0.05）. There was no significant difference of portal vein thrombosis between two groups（16.4% vs 29.2%, P〈0.05）. Conclusions LSSD is safe and effective in treatment of the patients with portal hypertension.

关 键 词：门静脉高压症 腹腔镜手术 选择性门奇静脉断流术 

分 类 号：R657.34[医药卫生—外科学]