手辅助腹腔镜与完全腹腔镜脾切除加门奇断流术的临床对比分析

A comparative study on the clinical efficacy of splenectomy plus porta-azygous devascularization in thetreatment of portal hypertension using either the hand-assisted or the laparoscopic approaches

目的探讨手辅助腹腔镜（手助腔镜）脾切除术加门奇断流术的临床效果。方法选择2008年1月至2012年6月在我院住院手术的30例门脉高压患者。分别采用手助腔镜（16例）和完全腹腔镜（全腔镜，14例）进行脾切除加门奇断流术，并对两组患者的临床效果进行对比分析。结果两组患者手术均顺利完成。手助腔镜组和全腔镜组手术时间分别为（270±21）min和（350±19）min，P〈0．05；术中出血量分别为（250±53）ml和（370±45）ml，P〈0．05；住院费用分别为（3．0±0．2）万元和（3．5±0．4）万元，P〈0．05；而术后排气时间、术后进半流质饮食时间、住院时间、并发症发生率两组差异无统计学意义（均为P〉O．05）。结论手助腔镜脾切除加门奇断流术同样具备全腔镜手术微创、安全、术后恢复快的优点。

Objective To study the clinical efficacy of splenectomy plus porta-azygous devascu larization in the treatment of portal hypertension using either the hand-assisted laparascopic （HALS） or the laparoscopic approaches. Methods The clinical data of 30 cases of portal hypertension treated between January 2008 and June 2012 were enrolled in this study. 16 patients underwent HALS and 14 patients underwent traditional laparoscopy approach. Results All the operations were successfully ac- complished. The mean operation time of the HALS group was significantly shorter than the traditional laparoscopic group （270 rain vs 350 min, P〈0.05）. Intra-operative blood loss of the HALS group was significantly less than the traditional laparoscopic group （250 ml vs 370 ml, P〈0.05）. The medi- an overall costs were significantly lower in the HALS group （30 000 RMB vs 35 000 RMB, P〈0.05）. There were no significant differences in the time to return to oral diet, the length of hospi- tal stay, and the time to passage of flatus. The complication rates between the two groups were simi- lar. Conclusion Hand-assisted laparoscopic surgery had the advantages over conventional laparoscopic surgery in minimal invasiveness, safety, and quicker postoperative recovery.