腹腔镜下断流术与开腹手术比较（附48例临床分析）

Laparotomic vs. laparoscopic splenectomy plus pericardial devascularization：A report of 48 cases

目的结合文献分析比较腹腔镜和开腹贲门周围血管离断术治疗门静脉高压症的疗效。方法回顾性分析2007年1月至2011年1月普外科采用腹腔镜贲门周围血管离断术治疗门静脉高压症48例及同期开腹手术215例的临床资料。结果所有手术均成功完成，手术时间腹腔镜组平均3．5h，与开腹组3．6h相似，腔镜组、开腹组术中出血分别为150ml和480．6ml，住院时间分别为9d和25．4d，并发症发生率分别为4例（8．3％）和28例（13．0％）。156例（59．3％）获随访，随访4～48个月，死亡5例。结论腹腔镜贲门周围血管离断术治疗门静脉高压症安全有效，出血少、恢复快，近期疗效优于开腹手术，但仍需行进一步研究。

Objective To compare the curative effect of laparotomic vs. laparoscopic splenectomy plus pericardial devascularization in the treatment of portal hypertension. Methods From Jan. 2007 to Jan. 201 l, there were 263 cases of portal hypertension admitted in our department, including 48 cases treated with laparoscopic splenectomy plus pericardial devascularization, and 215 cases receiving laparotomy. The data of these patients were analyzed retrospectively. Results All operations were conducted successfully. The mean operation time was similar between these two methods （3.5 h vs. 3.6 h）. As compared with laparotomic group, mean blood loss was reduced （150 mL vs. 480. 6 mL）, hospital stay was shortened （9 days vs. 25.4 days）, and postoperative complication incidence was decreased （8.3~/00 vs. 13. 0 ~） in laparoscopic group. 156 cases were followed up for 4-48 months and 5 cases died of chronic liver disease. Conclusion Laparoscopic pericardial devascularization in the treatment of portal hypertension is safe and reliable. It has lower bleeding rate and shorter recovery time than laparotomy.