腹腔镜脾切除术联合贲门周围血管离断术治疗肝硬化脾机能亢进的临床效果研究  

Study on the clinical effect of laparoscopic splenectomy combined with esophagogastric devascularization in treatment of liver cirrhosis-induced hypersplenism

作　　者：李晓欢 吴一鸣 徐鹿平 徐艳丽 LI Xiaohuan;WU Yiming;XU Luping;XU Yanli(Department of Hepatobiliary Surgery,Jiaxing First Hospital in Zhejiang Province,Jiaxing 314000,China;Department of Liver Disease,Jiaxing First Hospital in Zhejiang Province,Jiaxing 314000,China)

机构地区：[1]浙江省嘉兴市第一医院肝胆外科,浙江嘉兴314000 [2]浙江省嘉兴市第一医院肝病科,浙江嘉兴314000

出　　处：《中国现代医生》2018年第17期46-49,53,共5页China Modern Doctor

基　　金：浙江省科学计划项目(2017C33202);浙江省嘉兴市科技计划项目(2012AY1070-8)

摘　　要：目的探讨腹腔镜脾切除术(LS)联合贲门周围血管离断术(ED)在肝硬化脾机能亢进患者中的应用价值。方法回顾性分析2013年5月～2017年7月我院接收的120例肝硬化脾机能亢进患者,其中行LS+ED治疗60例,行开腹脾切除术(OS)+ED治疗60例。比较两组患者手术治疗效果、并发症发生情况,并于治疗前后检测两组患者的外周血细胞数量及肝功能指标。结果观察组术中出血量、术后引流量、肛门排气时间、住院时间均显著低于对照组(P<0.05),两组手术时间比较无明显差异(P>0.05)。两组术后2周白细胞计数、血小板计数均较术前显著上升(P<0.05),但红细胞计数无明显变化(P>0.05);且两组手术前后以上指标组间比较差异无统计学意义(P>0.05)。两组术后2周ALT、AST、TBIL水平均较术前显著下降(P<0.05),但ALB无明显变化(P>0.05);且两组手术前后上述肝功能指标组间比较无统计学差异(P>0.05)。观察组并发症发生率为15.00%(9/60),与对照组[48.33%(29/60)]比较显著降低(P<0.05)。结论 LS联合ED治疗肝硬化脾机能亢进可有效改善患者的肝功能、解除脾亢进状态,且手术创伤小、并发症少。Objective To evaluate the application value of laparoscopic splenectomy(LS)combined with esophagogastric devascularization(ED)in the patients with liver cirrhosis-induced hypersplenism.Methods 120 patients with liver cirrhosis-induced hypersplenism who were admitted to our hospital from May 2013 to July 2017 were retrospectively analyzed.Among them,60 patients were treated with LS+ED,and 60 patients were given open splenectomy(OS)+ED.The effect of surgical treatment and the occurrence of complications were compared between the two groups of patients.Before and after treatment,the peripheral blood cell count and liver function index were measured in both groups.Results The amount of intraoperative blood loss,postoperative drainage,anal exhaust time,and length of stay in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the operation time between the two groups(P>0.05).The white blood cell count and platelet count after surgery were significantly higher than those before surgery in both groups(P<0.05),but there was no significant change in the red blood cell count(P>0.05);there was no statistically significant difference in the above indexes between the two groups before and after the surgery(P>0.05).The levels of ALT,AST,and TBIL in the two groups were significantly lower than those before surgery(P<0.05),but there was no significant change in ALB(P>0.05);there was no statistically significant difference between the two groups in the above liver function index before and after surgery(P>0.05).The incidence rate of complications in the observation group was 15.00%(9/60),which was significantly lower than that in the control group[48.33%(29/60)](P<0.05).Conclusion LS combined with ED in the treatment of liver cirrhosis-induced hypersplenism can effectively improve the liver function and relieve hypersplenism in patients,with less trauma and fewer complications.

关 键 词：腹腔镜脾切除术 贲门周围血管离断术 肝硬化 脾机能亢进 肝功能 

分 类 号：R657.63[医药卫生—外科学]