腹腔镜脾切除联合贲门周围血管离断术诱导失代偿肝硬化再代偿的临床研究  

Clinical study on inducing recompensation of decompensated cirrhosis by laparoscopic splenectomy plus esophagogastric devascularization

作　　者：章铭 王栋 陈晓 梁德锋 曹彦龙 杨涛 黄博 鲁建国 阴继凯 ZHANG Ming;WANG Dong;CHEN Xiao;LIANG Defeng;CAO Yanlong;YANG Tao;HUANG Bo;LU Jianguo;YIN Jikai(Department of General Surgery,the Second Affiliate Hospital of Air Force Medical University,Xi’an,Shaanxi 710038,China)

机构地区：[1]空军军医大学第二附属医院普通外科,陕西西安710038

出　　处：《肝胆胰外科杂志》2025年第2期86-92,共7页Journal of Hepatopancreatobiliary Surgery

基　　金：空军军医大学第二附属医院科技创新发展基金重点项目(2019LCYJ005);空军军医大学第二附属医院临床新技术新业务项目(2022XJSXYW005)。

摘　　要：目的探究腹腔镜脾切除联合贲门周围血管离断术(LSED)对失代偿肝硬化患者实现再代偿的作用以及术后再代偿与患者预后的相关性。方法回顾性分析2013年11月至2022年3月空军军医大学第二附属医院因失代偿肝硬化行LSED的87例患者临床资料。按照BavenoⅦ标准对肝硬化再代偿的定义,依据术后第1年随访结果,将患者分成再代偿组(n=54)和非再代偿组(n=33)。采用Logistic回归法分析失代偿肝硬化再代偿的影响因素。采用Kaplan-Meier法绘制生存曲线,采用Cox回归法评估患者生存结局(术后1年发生消化道出血或肝癌)的影响因素。结果在87例患者中,有54例(62.1%)在LSED术后第1年实现了再代偿。术前吲哚菁绿15 min滞留率(ICG R15)<15%(校正OR=2.99,95%CI 1.11-8.02,P=0.030)、术后血小板(PLT)计数≥211×10~9/L(校正OR=2.96,95%CI 1.13-7.74,P=0.027)是影响LSED术后失代偿肝硬化再代偿的独立危险因素。再代偿组与非再代偿组LSED术后2、4、6年的累计无消化道出血或肝癌生存率为[98.1%vs 78.8%、92.6%vs 67.6%、77.1%vs 33.8%],差异均有统计学意义(均P<0.05)。多因素Cox回归分析显示,再代偿(校正HR=0.19,95%CI 0.07-0.54,P=0.002)是失代偿肝硬化患者LSED术后预后的独立保护因素。结论LSED术后1年内可使近六成失代偿肝硬化患者实现再代偿,LSED术后再代偿的患者消化道出血或肝癌发生风险显著降低。Objective To investigate the effects of laparoscopic splenectomy plus esophagogastric devascularization(LSED)on achieving recompensation in patients with decompensated cirrhosis,and to explore the correlation between postoperative recompensation and patient's prognosis.Methods The clinical data of 87 patients with decompensated cirrhosis who underwent LSED at the Second Affiliated Hospital of Air Force Medical University between Nov.2013 and Mar.2022 were retrospectively analyzed.Based on the BavenoⅦcriteria for cirrhosis recompensation and the follow-up results in the first year after LSED,all 87 patients were divided into the recompensation group(n=54)and the non-recompensation group(n=33).The Logistic regression analysis was used to explore the related factors for recompensation.The Kaplan-Meier method was used to construct survival curves.Additionally,the Cox regression model analysis was used to investigate the influencing factors for survival outcome(gastrointestinal bleeding or liver cancer occurring 1 year after LSED).Results Among all 87 patients,54(62.1%)achieved recompensation within the first year after LSED.The preoperative indocyanine green retention rate at 15 minute(ICG R15)<15%(adjusted OR=2.99,95%CI 1.11 to 8.02,P=0.030)and postoperative platelets≥211×10~9/L(adjusted OR=2.96,95%CI 1.13 to 7.74,P=0.027)were independent facilitating factors for recompensation.The cumulative survival rates without gastrointestinal bleeding or liver cancer at 2-,4-and 6-year after LSED in recompensation group and non-recompensation group were 98.1%vs 78.8%,92.6%vs 67.6%,77.1%vs 33.8%,respectively,and the differences were statistically significant(all P<0.05).Multivariate Cox regression analysis showed that,recompensation(adjusted HR=0.19,95%CI 0.07 to 0.54,P=0.002)was an independent protective factor for prognosis of patients with decompensated cirrhosis after LSED.Conclusion LSED can enable 60%of patients with decompensated cirrhosis to achieve recompensation within 1 year after surgery.Furthermore,the patient

关 键 词：肝硬化 失代偿 脾切除术 贲门周围血管离断术 门静脉高压症 再代偿 

分 类 号：R657.3[医药卫生—外科学] R657.6[医药卫生—临床医学]