改良手助腹腔镜和完全腹腔镜下脾切除加贲门周围血管离断术的比较研究

Modified hand-assisted versus total laparoscopic splenectomy and esophagogastric devascularization

目的 比较改良手助腹腔镜下和全腹腔镜下脾切除加贲门周围血管离断术治疗肝硬化门静脉高压症的临床效果.方法 回顾性分析2007年1月至2011年12月进行的47例改良手助腹腔镜下脾切除加贲门周围血管离断术（改良手助腹腔镜组）和38例完全腹腔镜下脾切除加贲门周围血管离断术（完全腹腔镜组）的患者临床资料.改良手助腹腔镜组先在手助腹腔镜下完成脾切除术,再改为完全腹腔镜下行贲门周围血管离断术.比较两组患者的手术时间、术中出血量、术后并发症和术后住院时间等资料.结果 改良手助腹腔镜组47例患者手术顺利,无中转开腹手术；完全腹腔镜组有2例患者因为术中出血中转开腹手术.改良手助腹腔镜组的平均手术时间为（154±32） min,术中出血量为（115±73） ml,均显著低于完全腹腔镜组[分别为（212±45） min和（172±57） ml].两组均无围手术期死亡.两组患者在术后胃肠功能恢复、平均术后住院时间和围手术期并发症发生率上差异无统计学意义.结论 改良手助腹腔镜下脾切除联合贲门周围血管离断术安全性好,操作方便,术中出血少,兼具手助腹腔镜和完全腹腔镜手术的优势,值得临床推广.

Objective To compare clinical outcomes of modified hand-assisted versus total laparoscopic splenectomy and esophagogastric devacularization for treatment of portal hypertension due to cirrhosis.Methods From Jan 2007 to Dec 2011,modified hand-assisted laparoscopic splenectomy plus esophagogastric devascularization （MHLSED） and total laparoscopic splenectomy and esophagogastric devascularization （LSED） were performed on 47 and 38 patients with portal hypertension due to cirrhosis,respectively.For the MHLESD group,we performed hand-assisted laparoscopic splenectomy first,then converted during operation to totally laparoscopic esophagogastric devascularization.The operating time,intra-operative blood loss,postoperative complications and postoperative hospitalization time were analyzed.Results MHLSED were performed on 47 patients successfully without any need to convert to open surgery,and LSED were performed on 36 patients with 2 patients having to convert to open surgery.The mean operative time [（154 ±32）min] and mean intra-operative blood loss [（115± 73）ml] in the HLSED group were significantly lower than the LSED group [（212±45）min and （172±57）ml,respectively].There was no mortality.There were no significant differences in the time period for gastrointestinal function to recover,postoperative hospital stay and overall complication rate between the two groups.Conclusions MHALSD is a relatively safe and efficacious treatment for portal hypertension due to cirrhosis.It combines the advantages of hand-assisted and totally laparoscopic operations.