改良腹腔镜脾脏切除+贲门周围血管离断术在肝硬化合并门静脉高压症中的应用研究  

Clinical analysis of modified laparoscopic splenectomy and pericardial devascularization for patients with cirrhosis complicated with portal hypertension

作　　者：汪昱[1] 董科[2] Wang Yu;Dong Ke(Department of Hepatobiliary Surgery,People's Hospital of Chongzhou City,Sichuan 611230,China;Department of Hepatobiliary Surgery,Sichuan Provincial People's Hospital,Sichuan 610072,China)

机构地区：[1]崇州市人民医院肝胆外科,成都611230 [2]四川省人民医院肝胆外科,成都610072

出　　处：《中华普外科手术学杂志（电子版）》2021年第1期65-68,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省卫生和计划生育委员会资助项目(WJ201768320)。

摘　　要：目的探究改良腹腔镜脾脏切除+贲门周围血管离断术(LSPD)治疗肝硬化合并门静脉高压症(PHT)的临床安全可行性。方法回顾性分析2015年3月至2019年4月临床确诊并行LSPD术的163例肝硬化PHT合并食管胃底静脉曲张和脾功能亢进患者进行研究。根据手术开展先后分为常规组(68例行常规LSPD术)和改良组(85例行改良LSPD术)。采用SPSS21.0统计软件进行数据分析,围术期各项指标等计量资料采用(x±s)表示,采用独立样本t检验;并发症发生率、中转开腹率等计数资料采用χ^2/Fisher检验。P<0.05差异有统计学意义。结果术中常规组4例中转开腹,改良组1例中转开腹,其余均顺利完成手术。改良组在手术时间、术中出血、术后恢复指标及并发症方面均明显优于常规组(P均<0.05)。改良组术后并发症总发生率14.1%低于常规组27.9%(χ^2=6.276,P=0.012)。结论肝硬化合并PHT患者行改良LSPD术安全可行,在缩短术时、减少出血、促进术后恢复方面具有显著优势,同时也可提高巨脾患者治疗效果,值得在临床推广应用。Objective To investigate the clinical safety and feasibility of modified laparoscopic splenectomy+pericardial devascularization(LSPD)in the treatment of cirrhosis complicated with portal hypertension.Methods A retrospective study was conducted in 163 patients with cirrhosis complicated with portal hypertension,including esophagogastric varices and hypersplenism who underwent LSPD from March 2015 to April 2019.According to the operation method,the patients were divided into the conventional group(68 cases of routine LSPD surgery)and the modified group(85 cases of modified LSPD surgery).Statistical analysis were performed by using SPSS21.0 software.Measurement data such as perioperative indicators were expressed as (x±s) and were analyzed by using independent sample t test.χ^2/Fisher test was used to examined the complication rate and the rate of conversion to laparotomy.A P value of<0.05 was considered as statistically significant difference.Results There were 4 cases of conversion to laparotomy in the conventional group,while 1 case in the modified group.The modified group was significantly better than the conventional group in terms of operation time,intraoperative bleeding,postoperative recovery index and complications rate(P<0.05).Total postoperative complications incidence of 14.1%in the modified group was significantly lower than 27.9%in the conventional group(χ^2=6.276,P=0.012).Conclusion Modified LSPD is safe and feasible for patients with cirrhosis complicated with portal hypertension,which has significant advantages in terms of shorter operation time,less bleeding and faster postoperative recovery,and could also improve the therapeutic effect of patients with giant spleen,which is worthy of clinical promotion.

关 键 词：肝硬化 高血压 门静脉 腹腔镜 脾切除术 贲门周围血管离断术 

分 类 号：R73[医药卫生—肿瘤]