腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症  

Laparoscopic Splenectomy for Massive Splenomegaly and Devascularization for Cirrhosis and Portal Hypertension

作　　者：刘成远 李俊江[1] 穆速 王坤[1] 韩祥松 崔广宾 Liu Chengyuan;Li Junjiang;Mu Su(Department of Gastrointestinal Hepatobiliary,First People’s Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]河南省商丘市第一人民医院胃肠肝胆三科

出　　处：《中国微创外科杂志》2020年第1期19-22,45,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症的可行性及效果。方法回顾性分析我院2015年8月~2018年8月巨脾切除联合贲门周围血管离断61例资料,其中腹腔镜29例,开腹32例,比较2组手术及并发症情况。结果2组手术时间、术后1周白细胞及血小板计数差异无显著性(P>0.05)。腹腔镜组术中出血量、排气时间、拔除引流管时间、术后住院时间均优于开腹组[中位数300(100,500)ml vs.330(150,550)ml,Z=-2.025,P=0.043;2(1,4)d vs.4(2,5)d,Z=-5.279,P=0.000;4(3,5)d vs.5(4,7)d,Z=-3.094,P=0.002;8(6,10)d vs.10(8,13)d,Z=-4.967,P=0.000]。腹腔镜组术后发热、切口感染、肺部感染、腹腔出血、胰漏发生率均低于开腹组,但差异无显著性(P>0.05)。腹腔镜组术后1周、2周、3个月门静脉系统血栓形成发生率均低于开腹组[13.8%(4/29)vs.40.6%(13/32),χ^2=5.449,P=0.020;17.2%(5/29)vs.46.9%(15/32),χ^2=6.062,P=0.014;17.2%(5/29)vs.50.0%(16/32),χ^2=7.232,P=0.007]。结论在条件充分情况下,肝硬化门脉高压采用腹腔镜巨脾切除加断流术治疗是可行的,且较开腹手术具有一定优势。Objective To explore the feasibility and effect of laparoscopic splenectomy for massive splenomegaly combined with devascularization in patients with hepatic cirrhosis of portal hypertension.Methods Clinical data of 61 patients admitted in our department treated with splenectomy for massive splenomegaly combined with pericardial devascularization were analyzed retrospectively,of which 29 cases were given laparoscopic surgery and 32 cases open surgery.The operation and complications of the two groups were compared.Results There were no significant differences in operation time,postoperative WBC and PLT between the two groups(P>0.05).In the laparoscopic group,the intraoperative blood loss,postoperative exhaust time,removal of drainage time,postoperative hospitalization time were less or shorter than those in the open group with statistically significant difference[M 300(P 25100,P 75500)ml vs.330(150,550)ml,Z=-2.025,P=0.043;2(1,4)d vs.4(2,5)d,Z=-5.279,P=0.000;4(3,5)d vs.5(4,7)d,Z=-3.094,P=0.002;8(6,10)d vs.10(8,13)d,Z=-4.967,P=0.000].The incidences of postoperative fever,postoperative infection,pulmonary infection,hemorrhage,and pancreatic leakage in the laparoscopic group were lower than those in the open group,but the differences were not statistically significant(P>0.05).The incidences of portal vein thrombosis at 1 week,2 weeks,and 3 months after operation were lower than those in the open group,and the differences were statistically significant[13.8%(4/29)vs.40.6%(13/32),χ^2=5.449,P=0.020;17.2%(5/29)vs.46.9%(15/32),χ^2=6.062,P=0.014;17.2%(5/29)vs.50.0%(16/32),χ^2=7.232,P=0.007].Conclusion Under sufficient conditions,using laparoscopic splenectomy combined with devascularization to treat hepatic cirrhosis of portal hypertension is feasible and has more advantages than the laparotomy.

关 键 词：腹腔镜 脾切除术 断流术 肝硬化 门静脉高压 

分 类 号：R73[医药卫生—肿瘤]