改良腹腔镜脾切除术+贲门周围血管离断术治疗门静脉高压症40例  

Clinical application effect of modified laparoscopic splenectomy combined with pericardial vasectomy in the treatment of 40 cases of portal hypertension

作　　者：席锐[1] 李涛[1] 唐寒秋[1] 陈宏[1] 李晓涛[1] 宋博[1] 王璐[1] 崔发强 杨瑞[1] 刘磊 高伟[1] 王丽娟[2] XI Rui;LI Tao;TANG Hanqiu;CHEN Hong;LI Xiaotao;SONG Bo;WANG Lu;CUI Faqiang;YANG Rui;LIU Lei;GAO Wei;WANG Lijuan(Department of Hepatobiliary Surgery,Hanzhong Central Hospital,Hanzhong,Shaanxi 723000,China;Quality Control Office,Hanzhong Central Hospital,Hanzhong,Shaanxi 723000,China)

机构地区：[1]汉中市中心医院肝胆外科,陕西汉中723000 [2]汉中市中心医院质控办,陕西汉中723000

出　　处：《安徽医药》2022年第9期1770-1773,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察改良腹腔镜脾切除术+贲门周围血管离断术(LSPD)在门静脉高压症中的应用效果。方法回顾性选取2016年7月至2019年7月在汉中市中心医院接受手术治疗的门静脉高压症病人80例为研究对象,并根据其手术方式的不同分为对照组和观察组,各40例,对照组病人给予LSPD术,观察组给予改良LSPD术。观察两组病人术中及术后恢复情况,比较两组病人手术前后炎性因子表达水平的差异。结果观察组病人手术时间、术中出血量、术后住院天数分别为(198.22±18.25)min、(232.43±15.22)mL、(10.79±1.12)d,低于对照组[(246.35±22.33)min、(425.74±16.73)mL、(12.98±2.04)d](P<0.05);观察组病人的术后肠鸣音恢复、首次肛门排气时间分别为(15.25±2.63)h、(28.42±3.13)h,低于对照组[(20.24±3.76)h、(35.16±4.02)h](P<0.05);两组中转开腹率差异无统计学意义(P>0.05);两组术式和时间的交互作用对血清白细胞介素(IL)-6、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)水平的影响差异有统计学意义(P<0.05)。术前两组各指标水平均差异无统计学意义(P>0.05),术后第1天及第7天观察组各指标水平均低于对照组(P<0.05)。时间因素对两组病人各指标的单独效应均差异有统计学意义(P<0.05),两组内两两时间点各指标均差异有统计学意义(P<0.05)。结论改良LSPD在门静脉高压症中的应用效果较好,可改善病人术后胃肠道功能,促进病人术后早期康复,具有良好的应用价值。Objective To observe the application effect of modified laparoscopic splenectomy and pericardial devascularization(LSPD)in portal hypertension.Methods A total of 80 patients with portal hypertension who received surgery treatment in Hanzhong Central Hospital from July 2016 to July 2019 were retrospectively selected as the research subjects,and were divided into the control group and the observation group according to their different surgical methods,with 40 cases in each group.The patients in the control group were given LSPD,and the patients in the observation group were given modified LSPD.The intraoperative and postoperative recovery of the two groups of patients was observed,and the differences in the expression levels of inflammatory factors before and after the operation were compared between the two groups.Results The operation time,intraoperative blood loss and postoperative hospital stay of the observation group were(198.22±18.25)min,(232.43±15.22)mL and(10.79±1.12)d,respectively,which were lower than those of the control group[(246.35±22.33)min,(425.74±16.73)mL,(12.98±2.04)d](P<0.05);the postoperative bowel sound recovery and first anal exhaust time of the observation group were(15.25±2.63)h and(28.42±3.13)h,respectively,which were lower than those of the control group[(20.24±3.76)h,(35.16±4.02)h](P<0.05).There was no significant difference in the rate of conversion to laparotomy between the two groups(P>0.05).The interaction of operation and time on serum interleukin(IL)-6,high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis-α(TNF-α)was statistically significant(P<0.05).There was no significant difference in the levels of each index between the two groups before the operation(P>0.05),and the levels of each index in the observation group were lower than those in the control group on the 1 st day and 7 th day after the operation(P<0.05).The time factor had a statistically significant difference in the individual effects of each index between the two groups of patients(P<0.05).Conclus

关 键 词：高血压 门静脉 脾切除术 腹腔镜 胃肠功能 炎性因子 

分 类 号：R657.6[医药卫生—外科学]