完全腹腔镜脾切除加门奇静脉断流术与开腹手术的临床对照研究

Clinical control study between totally laparoscopic splenectomy plus portal-azygous disconnection and laparotomy

目的:比较完全腹腔镜脾切除加门奇静脉断流术与开腹手术的近期临床效果,并探讨完全腹腔镜的手术方法、可行性及安全性。方法:回顾分析2005年1月至2008年12月我院行完全腹腔镜与同期开腹脾切除加门奇静脉断流术各36例患者的临床资料。结果:所有手术均获成功,腹腔镜组平均手术时间稍长于开腹组[(195±58)minvs.(154±39)min],而术中出血量[(392±165)mlvs.(693±204)ml]、术后下床活动时间[(41.3±23.9)hvs.(103.7±33.4)h]、排气时间[(2.1±0.9)dvs.(3.9±2.3)d]、住院时间[(13.6±2.3)dvs.(16.5±3.7)d]则明显少于开腹组。术后并发症如胰漏、肺部感染、切口感染及下肢深静脉血栓的发生率明显低于开腹组。两组住院费用差异无统计学意义。随访3～36个月,两组消化道再出血率差异无统计学意义。结论:完全腹腔镜脾切除加门奇静脉断流术治疗门静脉高压症安全可行,疗效确切,近期疗效明显优于开腹手术,值得临床推广。

Objective：To compare the short-term clinical effect of totally laparoscopic splenectomy plus portal-azygous disconnection with laparotomy on patients suffering from portal hypertension and to explore the procedure, feasibility and safety of totally laparoscopic surgery. Methods：The clinical data of 36 cases of totally laparoscopic spleneetomy plus portal-azygous disconnection and 36 cases of laparotomy from Jan. 2005 to Dee. 2008 was retrospectively analyzed. Results ： All operations were successful. The mean operation time was longer in the laparoscopic group than that in the open group [ （ 195 ± 58 ） rain vs. （ 154 ± 39 ） min, P 〈 0.05 ]. The laparoseopic group decreased significantly in blood loss [ （392 ± 165 ）ml vs. （693±204 ）ml, P 〈 0.01 ], postoperative off-bed activity time [ （ 41.3 ± 23.9 ） h vs. （ 103.7 ± 33.4） h, P 〈 0.01 ], anal exsufflation time [ （ 2.1 ± 0.9） d vs. （ 3.9 ± 2.3 ） d, P 〈 0.05 ], hospitalization [ （13.6± 2.3 ）d vs. （16.5 ±3.7 ）d ,P 〈 0.05 ] and postoperative complication such as pancreatic leakage,pulmonary infection, infection of incisional wound and deep venous thrombosis of lower limb （ P 〈 0.05 ）. There was no significant difference between the two groups in expenses of hospitalization and in upper gastrointestinal re-bleeding in 3 to 36 months follow-up （ P 〉 0.05 ）. Conclusions： The procedure of totally laparoscopic splenectomy plus portal-azygous disconnection is safe and feasible, with promising therapeutic effect and better short-term clinical effect than laparotomy, it is worth generalizing.