腹腔镜脾切除联合断流术中保留迷走神经在肝硬化门静脉高压患者中的应用  

Application of laparoscopic splenectomy combined with vagus nerve preservation during devascularization in patients with cirrhotic portal hypertension

作　　者：罗剑 何文法 LUO Jian;HE Wen-fa(Department of Surgery,Jianli Fifth People′s Hospital,Hubei Province,Jianli433300,China;The Second Department of Surgery,Jianli People′s Hospital,Hubei Province,Jianli433300,China)

机构地区：[1]湖北省监利市第五人民医院外科,湖北监利433300 [2]湖北省监利市人民医院外2科,湖北监利433300

出　　处：《中国当代医药》2021年第18期63-66,共4页China Modern Medicine

摘　　要：目的探究腹腔镜脾切除联合断流术中保留迷走神经在肝硬化门静脉高压患者中的应用效果。方法选取2015年3月~2020年1月于湖北省监利市第五人民医院就诊的74例肝硬化门静脉高压患者作为研究对象,按照随机数字表法分为对照组(n=37,采用腹腔镜脾切除联合断流术治疗)和观察组(n=37,在对照组治疗基础上保留迷走神经)。比较两组患者手术相关指标(手术时间、术中出血量、术后自由门静脉压、术后胃液引流量、住院时间),比较术前及术后3个月时两组生活质量[反流、消化不良生存质量量表(QOLRAD)评分],比较术后7 d内两组并发症(餐后腹胀、腹泻、胃潴留、门静脉血栓)发生率。结果观察组患者手术时间短于对照组,差异有统计学意义(P<0.05);观察组患者术中出血量、术后胃液引流量均少于对照组,差异有统计学意义(P<0.05);两组患者术后自由门静脉压、住院时间比较,差异无统计学意义(P>0.05)。术后3个月时,观察组患者的QOLRAD评分与同组术前比较,差异无统计学意义(P>0.05);对照组患者术后3个月时的QOLRAD评分低于同组术前,差异有统计学意义(P<0.05);观察组患者术后3个月时的QOLRAD评分高于对照组,差异有统计学意义(P<0.05)。术后7 d内,观察组患者餐后腹胀、腹泻、胃潴留生率均低于对照组,差异有统计学意义(P<0.05);两组患者门静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜脾切除联合断流术中保留迷走神经治疗肝硬化门静脉高压患者手术操作更便捷,且可有效维护患者胃功能,改善患者生存质量,减少相关并发症发生。Objective To explore the application effect of laparoscopic splenectomy combined with vagus nerve preservation during devascularization in patients with cirrhotic portal hypertension.Methods A total of 74 patients with cirrhotic portal hypertension treated in Jianli Fifth People′s Hospital,Hubei Province from March 2015 to January 2020 were selected as the research objects,and they were divided into control group(n=37,treated with laparoscopic splenectomy combined with devascularization)and observation group(n=37,given vagus nerve preservation on the basis of control group)according to the random number table method.The related surgical indicators(surgical time,intraoperative blood loss,postoperative free portal vein pressure,postoperative gastric juice drainage volume and hospital stay)were compared between the two groups,the quality of life(quality of life in reflux and dyspepsia questionnaire[QOLRAD]score)was compared between the two groups before surgery and at 3 months after surgery,and the incidence rates of complications(postprandial abdominal distension,diarrhea,gastric retention and portal vein thrombosis)were compared between the two groups within 7 d after surgery.Results The surgical time of the observation group was shorter than that of the control group,the difference was statistically significant(P<0.05).The intraoperative blood loss and postoperative gastric juice drainage volume in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the postoperative free portal vein pressure and hospital stay between the two groups(P>0.05).At 3 months after surgery,there was no significant difference in QOLRAD score in the observation group compared with that before surgery(P>0.05).The QOLRAD score at 3 months after surgery in the control group was lower than that of the same group before surgery,the difference was statistically significant(P<0.05).The QOLRAD score at 3 months after surgery in the observ

关 键 词：腹腔镜脾切除 断流术 保留迷走神经 肝硬化门静脉高压 胃功能 生存质量 

分 类 号：R575[医药卫生—消化系统]