改良保留迷走神经与传统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前瞻性随机对照研究  

Modified vagus nerve⁃preserving versus conventional laparoscopic splenectomy and azygoportal disconnec⁃tion for cirrhotic portal hypertension:a prospective randomized controlled trial

作　　者：蒋国庆 柏斗胜 金圣杰 张弛 王谦 周保换 王翱卿 吴龙飞 Jiang Guoqing;Bai Dousheng;Jin Shengjie;Zhang Chi;Wang qian;Zhou Baohuan;Wang Aoqing;Wu Longfei(Department of Hepatobiliary Surgery,Clinical Medical College,Yangzhou University,Yangzhou 225001,Jiangsu Province,China)

机构地区：[1]扬州大学临床医学院肝胆外科,江苏扬州225001

出　　处：《中华消化外科杂志》2020年第12期1280-1285,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(QNRC 2016331)。

摘　　要：目的探讨改良保留迷走神经与传统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。方法采用前瞻性随机对照研究方法。选取2018年4月至2019年2月扬州大学临床医学院收治的70例肝硬化门静脉高压症患者的临床病理资料。将研究对象按照随机数字表法分为传统手术组和改良手术组,传统手术组患者行传统腹腔镜脾切除联合贲门周围血管离断术,改良手术组患者行改良保留迷走神经腹腔镜脾切除联合贲门周围血管离断术。观察指标:(1)术中及术后情况。(2)随访情况。采用电话、门诊和住院方式进行随访。术后每3个月随访了解患者上消化道再出血、胃潴留、餐后饱胀、腹泻发生情况。术后1、6、12个月行电子胃镜检查,如食管曲张静脉直径>5 mm,则行内镜下套扎术。随访时间截至2020年2月。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示;计数资料以绝对数表示,组间比较采用χ^2检验或Fisher确切概率法。结果筛选出符合研究条件的肝硬化门静脉高压症患者70例,男51例,女19例;年龄为(52±12)岁,年龄范围为22~78岁;传统手术组和改良手术组各35例,研究过程中传统手术组1例患者退出。(1)术中及术后情况:传统手术组患者手术时间、术中出血量、术中输血、中转开腹分别为(160±26)min、(76±104)mL、0、1例,改良手术组上述指标分别为(135±27)min、(65±68)mL、1例、0。两组患者手术时间比较,差异有统计学意义(t=-3.946,P<0.05),术中出血量比较,差异无统计学意义(t=-0.562,P>0.05);术中输血、中转开腹比较,差异均无统计学意义(P>0.05)。两组患者术中均未额外行止血手术。传统手术组患者术后胰液漏、肺部感染、腹腔感染、术后7 d门静脉血栓、住院时间分别为2例、1例、1例、16例、(9.5±1.4)d,改良手术组上述指标分别为1�Objective To investigate the clinical efficacy of modified vagus nerve⁃preserving laparoscopic splenectomy and azygoportal disconnection(MVLSD)versus conventional laparoscopic splenectomy and azygoportal disconnection(CLSD)for cirrhotic portal hypertension.Methods The prospective randomized controlled study was conducted.The clinicopathological data of 70 patients with cirrhotic portal hypertension who were admitted to Clinical Medical College of Yangzhou University from April 2018 to February 2019 were collected.Patients were divided into two groups based on a random table.Patients undergoing CLSD were allocated into conventional group,and patients undergoing MVLSD were allocated into modified group,respectively.Observation indicators:(1)intraoperative and postoperative situations;(2)follow⁃up.Follow⁃up was conducted by telephone interview,outpatient and inpatient examination.Patients were followed up once every 3 months to detect upper digestive rebleeding,gastric retention,postprandial fullness and diarrhea.Electronic gastroscopy was performed on patients at postoperative 1,6,12 months.Endoscopic variceal ligation was made if the diameter of the esophageal varices was>5 mm.The follow⁃up was up to February 2020.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was analyzed using the chi⁃square test or Fisher exact probability.Results A total of 70 patients with cirrhotic portal hypertension were selected for eligibility,including 51 males and 19 females,aged(52±12)years,with a range from 22 to 78 years.There were 35 and 35 patients in conventional group and modified group,respectively.One patient withdrew from the study.(1)Intraoperative and postoperative situations:operation time,volume of intraoperative blood loss,cases with intraoperative transfusion,cases with conversion t

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：R575.2[医药卫生—消化系统]