保留迷走神经的腹腔镜脾切除联合断流术治疗门静脉高压症的疗效评价  

Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection

作　　者：蒋国庆 柏斗胜 陈平 钱建军 姚捷 金圣杰 王小东 高志慧 Jiang Guoqing;Bai Dousheng;Chen Ping;Qian Jianjun;Yao Jie;Jin Shengjie;Wang Xiaodong;Gao Zhihui(Department of Hepatobiliary Surgery,Clinical Medical College of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院肝胆外科,江苏省225001

出　　处：《中华普通外科杂志》2018年第7期548-551,共4页Chinese Journal of General Surgery

基　　金：江苏省青年医学人才资助项目（QNRC2016331）;江苏省卫生计生委面上科研资助项目（H201661）;江苏省六个一工程拔尖人才资助项目（LGY2017029）

摘　　要：目的探讨保留迷走神经的腹腔镜脾切除联合断流术治疗门静脉高压症的安全性及疗效。方法回顾性分析2015年4月至2016年9月扬州大学临床医学院肝胆外科收治的60例肝硬化性门静脉高压患者的临床资料，根据术中是否保留迷走神经分为非保留迷走神经组（37例）和保留迷走神经组（23例）。结果非保留迷走神经组的手术时间长于保留迷走神经组[（169±42）min比（147±21）min，t=2．684，P〈0．05]。非保留迷走神经组术后的总并发症（102例）、胃潴留（35例）、餐后腹胀（22例）和腹泻（26例）的发生率均高于保留迷走神经组（21例次、2例、2例和2例），两组比较差异均有统计学意义（疋。=29．583、44．272、15．229、21．606，均P〈0．05）。术后第6个月时，非保留迷走神经组的体重低于保留迷走神经组，差异有统计学意义[（63±10）kg比（70±12）kg，t=-2．546，P〈0．05]；术后第6个月时，非保留迷走神经组的血浆白蛋白水平低于保留迷走神经组，差异有统计学意义[（42±6）g／L比（46±5）g／L，t=-2．607，P〈0．05]。结论保留迷走神经的腹腔镜脾切除联合断流术是安全可行的，并且减少了术后并发症。Objective To investigate the clinical safety and value of vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection. Methods A total of 60 cirrhotic patients with bleeding portal hypertension undergoing modified laparoscopic splenectomy and azygoportal disconnection between Apr 2015 and Sep 2016 were retrospectively analyzed. Patients were divided into non-vagus nerve-preserving （ n = 37 ） and vagus nerve-preserving group （ n = 23 ）. Results Operative time （169±42 ） min, and incidences of postoperative complications （ 102/370 ） , delayed gastric emptying （ 35/37 ） , epigastric fullness （ 22/37 ） , diarrhea （ 26/37 ） in non-vagus nerve-preserving group were all more than those in vagus nerve-preserving group [ （ 147±21 ） min, （ 21/230 ） , （ 2/23 ） , （ 2/23 ） , （ 2/23 ） ] （ t = 2. 684 ,X^2 = 29. 583, 44. 272, 15. 229, 21. 606, all P 〈 0. 05）. There was no significant between-group difference in body weight at admission and on postoperative day 7 （POD 7 ） between the two groups. However, body weight in vagus nerve-preserving group was significantly higher on postoperative 6 month （POM） compared with that in non-vagus nerve-preserving group [ （63 ±10） kg vs. （70±12） kg, t = 2. 546, P 〈 0. 051. There was no significant between-group difference in ALB levels at admission and on POD 7 between the two groups. However, ALB levels in vagus nerve-preserving group at POM 6 were significantly higher than those in non-vagus nerve-preserving group [ （42±6 ） g/L vs. （ 46±5 ） g/L, t = - 2. 607, P 〈 0. 05 ]. Conclusion Vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection for cirrhotic portal hypertension is safe, feasible and with good therapeutic effect.

关 键 词：高血压 门静脉 迷走神经 腹腔镜 断流术 

分 类 号：R657.34[医药卫生—外科学]