腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症临床疗效分析(附425例报告)  

Clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension:a report of 425 cases

作　　者：蒋国庆 柏斗胜 钱建军 金圣杰 张弛 王谦 周保换 王翱卿 Jiang Guoqing;Bai Dousheng;Qian Jianjun;Jin Shengjie;Zhang Chi;Wang Qian;Zhou Baohuan;Wang Aoqing(Department of Hepatobiliary Surgery,Clinical Medical College,Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院肝胆外科,225001

出　　处：《中华消化外科杂志》2019年第12期1136-1141,共6页Chinese Journal of Digestive Surgery

基　　金：江苏省卫生厅面上科研课题资助项目(H201661);江苏省青年医学人才资助项目(QNRC2016331)。

摘　　要：目的探讨腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的临床疗效。方法采用回顾性描述性究方法。收集2012年2月至2018年12月扬州大学附属苏北人民医院收治的425例行腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症患者的临床病理资料;男289例,女136例;年龄为(53±11)岁,年龄范围为21~79岁。根据手术时间,将425例患者分为3个时期:早期(2012年2月至2014年3月)100例、技术成熟期(2014年4月至2016年8月)156例、技术创新期(2016年9月至2018年12月)169例。早期、技术成熟期患者行腹腔镜脾切除联合贲门周围血管离断术,技术创新期患者行保留迷走神经的腹腔镜脾切除联合贲门周围血管离断术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊方式对患者进行随访,了解患者上消化道再出血、胃潴留、腹泻发生情况。根据随访患者门诊胃镜检查结果行内镜下套扎术序贯治疗。随访时间截至2019年3月。正态分布的计量资料以x􀭰±s表示,多组间比较采用方差分析,两两比较采用t检验;偏态分布的计量资料以M(范围)表示,多组间比较采用Kruskal⁃Wallis秩和检验,两两比较采用秩和检验;计数资料以绝对数和(或)百分率表示,组间比较采用χ2检验或Fisher确切概率法。结果(1)手术情况:早期患者手术时间,术中出血量,术中输血例数,中转开腹例数,急诊止血例数分别为(187±46)min,150 mL(50~1300 mL),2例,2例,1例。技术成熟期和技术创新期患者上述指标分别为(164±22)min,50 mL(30~100 mL),1例,1例,1例和(150±18)min,50 mL(10~300 mL),0,0,0。3期患者手术时间、术中出血量比较,差异均有统计学意义(F=55.482,χ^2=94.620,P<0.05)。3期患者术中输血、中转开腹、急诊止血例数比较,差异均无统计学意义(P>0.05)。(2)术后情况:425例患者无围术期死亡,术后常规口服阿司匹林肠溶片预防血�Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected.There were 289 males and 136 females,aged(53±11)years,with a range from 21 to 79 years.All the patients were allocated into 3 periods according to the operation time,including 100 patients of early period from February 2012 to March 2014,156 patients of mature technology period from April 2014 to August 2016,and 169 patients of technology innovation period from september 2016 to December 2018.The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization,and the patients of technology innovation period underwent vagus nerve⁃preserving laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow⁃up.Patients were followed up by outpatient examination to detect the upper digestive rebleeding,gastric retention,and diarrhea up to March 2019.Sequential therapy of endoscopic variceal ligation(EVL)was slectively performed on patients based on results of gastroscopy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using ANOVA,and paired comparison was analyzed using the t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was anlyzed using the Kruskal⁃Wallis rank sum test,and paired comparison was analyzed using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi⁃square test and Fisher exact probability.Results(1)Sur

关 键 词：肝硬化 门静脉高压症 脾切除术 贲门周围血管离断术 迷走神经 腹腔镜检查 

分 类 号：R73[医药卫生—肿瘤]