门静脉高压症断流术中脾动脉结扎和脾切除的临床疗效比较  

Splenic artery ligation versus splenectomy in periesophagogastric devascularization for portal hypertension

作　　者：李秋生[1] 王乐 冯峰 邢中强 张建生[1] 王文斌[1] 吕海涛[1] 刘建华[1] Li Qiusheng;Wang Le;Feng Feng;Xing Zhongqiang;Zhang Jiansheng;Wang Wenbin;Lyu Haitao;Liu Jianhua(Department of Hepatobiliary and Pancreatic Surgery,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肝胆胰腺外科,石家庄050000

出　　处：《中华普通外科杂志》2021年第1期34-38,共5页Chinese Journal of General Surgery

基　　金：河北省卫生厅项目-医学科学研究课题计划项目(20190587)。

摘　　要：目的︰探讨腹腔镜脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症的可行性与有效性。方法︰回顾性分析2014年1月至2019年12月河北医科大学第二医院手术治疗的80例肝硬化门静脉高压症患者的临床资料,其中50例行腹腔镜脾动脉结扎联合贲门周围血管离断术,30例行腹腔镜脾切除联合贲门周围血管离断术。结果与脾切除组相比,脾动脉结扎组手术时间短[(181±72)min比(284±72)min,t=-6.205,P<0.01],术中失血量少[(100±50)ml比(700±86)ml,t=-5.166,P<0.01],输血率低(28%比67%,Χ^(2)=11.471,P<0.01),差异均有统计学意义;脾动脉结扎组术后排气时间短于脾切除组(2d比3 d,Z=2.361,P<0.05);脾切除组术后外周血白细胞和血小板计数上升程度高于牌动脉结扎组(P<0.05);脾切除组10例术后出现门静脉血栓,脾动脉结扎组6例术后出现门静脉血栓,差异有统计学意义(Χ^(2)=5.757,P<0.05)。结论﹐与腹腔镜脾切除联合贲门周围血管离断术相比,腹腔镜脾动脉结扎联合贲门周围血管离断术治疗门静脉高压症具有手术方式相对简单、创伤小,门静脉系统血栓形成发生率低等优势。Objective To evalte a novel laparoscopic splenic artery ligation plus devascularization(LSALD)vs.laparoscopic splenectomy and devascularization(LSD)for the treatment of portal hypertention.Methods From Jan 2014 to Dec 2019,50 patients undergoing LSALD and 30 patients receiving LSD.We compared the safety and feasibility between LSALD and LSD groups by analyzing the patients’blood routine,liver function before and after operation,intraoperative condition,postoperative recovery and prognosis.Results The operation time[(181±72)min vs.(284±72)min=-6.205,P<0.01],intraoperative blood loss[(100±50)ml 700±86 ml),f=-5.166,P<0.01]and blood transfusion rate(28%vs.67%,Χ^(2)=11.471(P<0.01)in LSALD group were significantly more favorite than those in LSD group(P<0.05).The postoperative exhaust in the (LSAIJ)group was earlier than that in the LSD group(2d vs.3 d,Z=2.361,P<0.05)though the WBC and blood platelet count was higher in LSD group(P<0.05).Portal vein thrombosis occurred in 10 cases in LSD group and 6 cases in LSALD group(Hypertension,portal;Splenic artery;Ligation;Splenectomy;Laparoscopy=5.757,P<0.05).Conclusion Compared with laparoscopic splenectomy combined with periesophagogastric devascularization,laparoscopic splenic artery ligation combined with periesophagogastric devascularization is less traumatic,helping quick recovery and lower rate of post-op portal vein thrombosis.

关 键 词：高血压 门静脉 脾动脉 结扎术 脾切除术 腹腔镜 

分 类 号：R657.3[医药卫生—外科学]