腹腔镜与开腹手术治疗门脉高压症的对比研究  

Comparative observation of laparoscopic and laparotomy surgery in the treatment of portal hypertension

作　　者：张杰 邢智 刘歆农[1] 李萍[1] 管文贤[2,4] Zhang Jie;Xing Zhi;Liu Xinnong;Li Ping;Guan Wenxian(Department of general surgery,the Affiliated Hospital of Yangzhou University,Jiangsu 225012,China;Department of general surgery,Drum Tower Clinical Medical College of Nanjing Medical University,Jiangsu 210008,China;Department of anesthesiology,the Affiliated Hospital of Yangzhou University,Jiangsu 225012,China;Department of general surgery,Nanjing Drun Tower Hospital,the Affiliated Hospital of Narnjing University Medical School,Jiangsu 210008,China)

机构地区：[1]扬州大学附属医院普通外科 [2]南京医科大学鼓楼临床医学院普通外科 [3]扬州大学附属医院麻醉科 [4]南京大学医学院附属鼓楼医院普通外科

出　　处：《中华普外科手术学杂志（电子版）》2020年第2期140-143,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81871317)。

摘　　要：目的探讨腹腔镜与开腹手术行脾切除联合贲门周围血管离断术治疗门脉高压症的手术效果。方法回顾性分析2013年3月至2018年12月因门脉高压、脾大、脾功能亢进及食管胃底静脉曲张行脾切除术联合贲门周围血管离断术的患者资料,其中腹腔镜下手术21例(腹腔镜组),开腹手术50例(开腹组)。应用GraphPad Prism 6.0软件对所有数据进行分析。术中、术后相关指标采用(x±s)表示,独立样本t检验;并发症发生率采用χ^2检验。P<0.05为差异有统计学意义。结果与开腹组比较,腹腔镜组手术时间较长(P<0.05),而术中出血量、切口长度、术后排气时间、镇痛药物使用次数、引流管拔除时间、术后住院时间、术后切口感染率均少于开腹组(P<0.05);两组间的腹腔出血、腹、盆腔积液、肺部感染、胰瘘以及门静脉血栓形成差异无统计学意义(P>0.05)。结论腹腔镜手术治疗门脉高压症行脾切除联合贲门周围血管离断术具有手术创伤小、术中出血少、术后恢复快、术后切口感染率低、住院时间短等优点,腹腔镜手术治疗门脉高压症是安全、可行的。Objective To observe and to compare the efficacy of laparoscopic and laparotomy splenectomy and pericardial devascularization in the treatment of portal hypertension.Methods From March 2013 to December 2018,clinical data of patients with portal hypertension for splenomegaly,hypersplenism and esophageal and gastric fundus varices were analyzed retrospectively,among them,21 cases underwent laparoscopic splenectomy and pericardial devascularization(laparoscopic group)and 50 cases underwent laparotomy of splenectomy and pericardial devascularization(laparotomy group).Statistical analysis were performed by using GraphPad Prism 6.0 software.Measurement data such as intraoperative and postoperative indicators were expressed as (x±s) and examined by using independent t-test.The complication rate were compared by usingχ^2 test.Survival were analyzed by using Kaplan Meier method,and were examined by using log rank test.A P value of<0.05 was considered as statistically significant difference.Results Compared with laparotomy group,in addition to much longer operating time(P<0.05),there were advantages observed in the laparoscopic group including intraoperative blood loss,length of incision,time of first postoperative flatus,usage of analgesics,removal time of drainage tube,postoperative hospital stay and postoperative incision infection rate(P<0.05).There were no significant differences between two groups in terms of abdominal bleeding,peritoneal and pelvic effusion,pulmonary infection,pancreatic fistula and portal vein thrombosis(P>0.05).Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension has the advantages of less surgical trauma,less intraoperative bleeding,faster postoperative recovery,lower incidence of postoperative incision infection,and shorter hospital stay.Laparoscopic surgery for the treatment of portal hypertension is safe and feasible.

关 键 词：高血压 门静脉 脾切除术 腹腔镜 剖腹术 疗效比较研究 

分 类 号：R657.34[医药卫生—外科学]