腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响  

Comparison of laparoscopic and open surgery on early postoperative liver function and coagulation function in patients with abdominal external hernia and cirrhosis

作　　者：王浩源 汪海洋[1] 孙建明[1] 陈以宽[1] 祁小桐[1] 唐博 Wang Haoyuan;Wang Haiyang;Sun Jianming;Chen Yikuan;Qi Xiaotong;Tang Bo(Department of Vascular Surgery&Hernia&Abdominal Wall Surgery,Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China;Department of General Surgery,University-town Hospital,Chongqing Medical University,Chongqing 401331,China)

机构地区：[1]重庆医科大学附属第二医院血管疝与腹壁外科,400010 [2]重庆医科大学附属大学城医院普外科,401331

出　　处：《中华疝和腹壁外科杂志(电子版)》2024年第6期654-659,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜与开放疝修补术对成人腹外疝合并肝硬化患者术后早期肝功能及凝血功能的影响及其临床意义。方法回顾性分析2019年1月至2024年9月,在重庆医科大学附属第二医院接受疝修补术的126例腹外疝合并肝硬化成人患者的临床资料。根据手术方式将患者分为腹腔镜手术组与开放手术组。主要评估指标包括肝功能[白蛋白、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素、终末期肝病模型评分(MELD)]、凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)]、手术时间、术后并发症及复发率。结果2组患者在年龄、性别、高血压和糖尿病等方面差异无统计学意义。急诊患者均采用开放手术,腹腔镜手术组的手术时间显著长于开放手术组。围手术期肝功能与凝血功能手术前后对比分析显示,腹腔镜手术组患者术后白蛋白水平显著下降,ALT、AST、总胆红素及MELD等指标值均有显著增加(P<0.05);开放手术组术后白蛋白、ALT、AST水平显著降低(P<0.05);而2组凝血功能指标均无显著变化(P>0.05)。在肝功能Child-Turcotte-Pugh(CTP)分级为A、B级的患者中,腹腔镜手术组术后并发症发生率及疝复发率低于开放手术组;而在CTP分级C级患者中,术后肝衰竭发生率及死亡率显著高于开放手术组。结论对于合并肝硬化的腹外疝患者,腹腔镜手术相较于开放修补手术对肝功能的影响更为显著。腹腔镜手术能显著降低CTP A级或B级患者的术后并发症发生率与疝复发率,但对于CTP C级患者,腹腔镜手术显著增加了术后肝衰竭及死亡的风险。因此,在临床实践中,需根据患者具体情况谨慎选择手术方式。Objective To explore the effects of laparoscopic versus open hernia repair on early postoperative liver function and coagulation function in adult patients with abdominal external hernias complicated by cirrhosis and to assess their clinical significance.Methods A retrospective analysis was conducted on the clinical data of 126 adult patients with abdominal external hernias and cirrhosis who underwent hernia repair surgery at the Second Affiliated Hospital of Chongqing Medical University from January 2019 to September 2024.Patients were divided into a laparoscopic surgery group and an open surgery group based on the surgical approach.The primary outcomes included liver function[albumin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin,Model for End-Stage Liver Disease(MELD)score],coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(FIB)],surgical duration,postoperative complications,and recurrence rates.Results There were no significant differences between the two groups regarding age,gender,hypertension,or diabetes.Emergency cases all underwent open surgery,and the laparoscopic surgery group had significantly longer operative times than the open surgery group.A comparison of perioperative liver and coagulation function showed that,in the laparoscopic surgery group,postoperative albumin levels significantly decreased,while ALT,AST,total bilirubin,and MELD scores significantly increased(P<0.05).In the open surgery group,postoperative albumin,ALT,and AST levels significantly decreased(P<0.05).The coagulation function parameters of both groups showed no significant changes(P>0.05).Among patients with Child-Turcotte-Pugh(CTP)class A and B liver function,the laparoscopic surgery group had a lower incidence of postoperative complications and hernia recurrence compared to the open surgery group.However,in CTP class C patients,the incidence of postoperative liver failure and mortality was significantly higher in th

关 键 词：腹腔镜 腹外疝 肝硬化 疝修补术 并发症 安全性 

分 类 号：R47[医药卫生—护理学]