腹腔镜脾切除断流联合术中内镜下套扎术防治术后食管胃底静脉曲张破裂再出血  

Laparoscopic splenectomy and azygoportal disconnection with intraoperative endoscopic variceal ligation in the prevention of postoperative recurrent bleeding

作　　者：周保换 蒋国庆 柏斗胜 钱建军 金圣杰 张弛 Zhou Baohuan;Jiang Guoqing;Bai Dousheng;Qian Jianjun;Jin Shengjie;Zhang Chi(Department of Hepatobiliary Surgery,Medical College of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学临床医学院肝胆外科,扬州225001

出　　处：《中华普通外科杂志》2023年第7期510-514,共5页Chinese Journal of General Surgery

基　　金：扬州市科技计划项目(YZ2021077);江苏省六大人才高峰资助项目(WSW-230)。

摘　　要：目的评价腹腔镜脾切除断流术(LSD)联合术中内镜套扎术(LSDL)防治术后食管胃底静脉曲张破裂再出血(EVR)的临床疗效。方法纳入2020年1月至2021年12月期间扬州大学临床医学院共90例肝硬化门静脉高压症伴脾功能亢进和食管胃底静脉曲张破裂出血(EVB)的患者,被随机分配接受LSD(n=45)或LSDL(n=45)治疗,主要评价结果为EVR。结果两组患者在术中出血量、输血发生率、首次肛门排气时间、首次下床活动时间及术后住院时间方面差异均无统计学意义(均P>0.05)。与LSD组相比,LSDL组手术时间延长[(140±21)min比(150±19)min,t=2.420,P=0.018],差异有统计学意义。术后1年随访结果显示:LSDL组EVR发生率显著降低(2%比18%,P=0.030)。单因素分析和多因素Logistic回归分析显示:LSDL是EVR的独立保护因素(P<0.05)。结论LSDL手术不仅在技术上是安全、可行的,而且与单纯LSD相比能更有效地降低术后EVR的风险。Objective To evaluate the clinical efficacy of laparoscopic splenectomy and azygoportal disconnection(LSD)with intraoperative endoscopic variceal ligation(LSDL)in the treatment of esophagogastric variceal bleeding(EVR).Method In this study,90 cirrhotic patients with esophagogastric variceal bleeding(EVB)were divided to receive either LSD(n=45)or LSDL(n=45)from Jan 2020 and Dec 2021.Results There were no significant differences in estimated blood loss,incidence of blood transfusion,time to first flatus,off-bed activity and postoperative hospital stay between the two groups(all P>0.05).Compared with LSD group,operation time was longer in LSDL group[(140±21)min vs.(150±19)min,t=2.420,P=0.018].LSDL was associated with significantly decreased EVR rate in one year follow-up(2%vs.18%,P=0.030).Univariate analysis and multivariate logistic regression revealed that LSDL was a significant independent protective factor for EVR as compared with LSD(P<0.05).Conclusion LSDL procedure is not only technically feasible and safe,it also contributed to lower postoperative EVR risk than single LSD.

关 键 词：高血压 门静脉 食管和胃静脉曲张 出血 内镜下套扎 

分 类 号：R654.4[医药卫生—外科学]