腹腔镜脾切除术治疗肝硬化门静脉高压症中对脾蒂血管的不同处理方式比较  

Comparison of different management methods of splenic pedicle vessels in laparoscopic splenectomy for portal hypertension of liver cirrhosis

作　　者：张菊梅 黄玉荣 王迪迪 李强 吴霞[1] 杨杰 Zhang Jumei;Huang Yurong;Wang Didi;Li Qiang;Wu Xia;Yang Jie(Guizhou Medical Unitersity,Guiyang Guizhou Province 50004,China;Department of Gastroenterology,The People'8 Hospital of Liupanshui eiry,Liupanshui Guishou Prorince 553000,China;Department of General Surgery,The Second Peple's Hospital of Guiyang,Guiyang Guizhou Proeince 550081,China;Department of Gastroenterology,The Afiliated Hospital of Guishou Medical University,Guiyang Guizhou Province 50004,China)

机构地区：[1]贵州医科大学,贵阳550001 [2]六盘水市人民医院消化内科,贵州六盘水553000 [3]贵阳市第二人民医院普外科,贵阳550081 [4]贵州医科大学附属医院消化内科,贵阳550025

出　　处：《中华普外科手术学杂志（电子版）》2022年第6期643-646,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2020年贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-074)。

摘　　要：目的:比较腹腔镜脾切除术治疗肝硬化门静脉高压症中脾蒂血管的不同处理方式对术后的影响。方法:回顾性分析2017年9月至2020年2月接受手术治疗的129例肝硬化门静脉高压症患者病例资料,根据术中脾蒂血管处理方式的不同分为A组(n=67例,残留脾动脉长度≥脾静脉)和B组(n=62例,残留脾动脉长度<脾静脉)。采用SPSS 26.0统计分析软件,手术相关指标、术后疼痛情况以(x±s)表示,采用独立样本t检验;术后门静脉血栓(PVT)发生率采用χ^(2)检验。P<0.05为差异有统计学意义。结果:两组患者手术时间、术中出血量、术后下床时间、术后肠胃减压时间、住院时间相比,差异无统计学意义(P>0.05)。A组患者术后1周门静脉内径、最大流速、血流量均比B组高(P<0.05);A组患者术后PVT发生率10.4%低于B组27.4%(P<0.05)。结论:对肝硬化门静脉高压症患者采用腹腔镜脾切除术治疗中,残留脾动脉长度不短于脾静脉,可有效改善肝脏血流动力学指标,降低术后PVT发生风险,临床应用价值高。Objective To compare the effect of different management methods of splenic pedicle vessels in laparoscopic splenectomy for cirrhotic portal hypertension.Methods The clinical data of 129 patients with cirrhotic portal hypertension who underwent surgical treatment from September 20i7 to February 2020 were retrospectively analyzed.They were divided into group A(n=67,residual splenic artery length≥splenic vein)and group B(n=62,residual splenic artery length<splenic vein)according to the dfferent treatment methods of splenic pedicle vessels during operation.SPSS 26.0 statistical analysis software was.used.The indexes related to surgery and postoperative pain were expressed as(x±s),and independent sample t test was used.The incidence of postoperative portal vein thrombosis(PVT)was analyzed by X test.P<0.05 was considered statistically significant.Results There were no significant differences in operation time,intraoperative blood loss,postoperative ambulation time,postoperative gastrointestinal decompression time,and hospital stay between the two groups(P>0.05).The diameter,maximum velocity and blood flow of portal vein in group A were higher than those in group B at 1 week after operation(P<0.05).The incidence of postoperative PVT in group A was 10.4%lower than that in group B 27.4%(P<0.05).Conclusion In the treatment of cirrhotic patients with portal hypertension by laparoscopic splenectomy,the length of residual splenie artery should not he shoter than that of splenic vein, which can efetively improve liver hemodynamiceindexes and reduce the risk of postoperative PVT, and has high elinical application value.

关 键 词：肝硬化 门静脉高压症 脾切除术 腹腔镜 脾蒂血管 手术后并发症 

分 类 号：R657.6[医药卫生—外科学] R575.2[医药卫生—临床医学]