手助腹腔镜与完全腹腔镜脾切除加门奇静脉断流术治疗肝硬化并门静脉高压的对照研究

A comparative study of hand-assisted laparoscopic versus total laparoscopic splenectomy plus portal-azygous disconnection for portal hypertension in liver cirrhosis

目的 探讨手助腹腔镜脾切除加门奇静脉断流术的安全性、可行性.方法 选取我院2008年3月～2013年2月收治的门静脉高压症患者58例,根据患者经济状况及意愿分成两组,其中手助腹腔镜（HALS）组31例,全腹腔镜（TLS）组27例,分别进行手助腹腔镜和完全腹腔镜脾切除加门奇静脉断流术.比较两组患者的手术时间、术中出血量、中转开腹率、切口感染发生率、肠道功能恢复时间、术后住院时间,统计学方法采用卡方检验及t检验.结果 本组58例患者均顺利完成手术,两组在术中出血量、切口感染发生率、肠道功能恢复时间、术后住院时间方面比较,差异均无统计学意义（P＞0.05）.HALS组在手术时间、中转开腹率方面明显少于TLS组,差异有统计学意义（P＜0.05）.结论 手助腹腔镜脾切除加门奇静脉断流术保留了微创优势的同时,又降低了手术难度,安全可靠,值得临床推广应用.

Objective To explore the safety and feasibility of hand-assisted laparoscopic splenectomy plus portal-azygous disconnection for portal hypertension in liver cirrhosis. Methods From March 2008 to February 2013, 58 patients with portal hypertension were divided into two groups according to the patients＇ economic situation and wishes. HALS group was performed in 31 patients and were treated with hand-assisted laparoscopic operations, and TLS group in the other 27 patients were treated with total laparoscopic operations. The patient＇s operation time, intraoperative bleeding volume, conversion to open surgery, wound infection rate, intestinal function recovery time, postoperative flatus time and hospital stay in both groups were compared. Chi-square test and t test was used. Results Fifty-eight patients were successfully operated. There were no significant differences in the aspects of intraoperative bleeding, wound infection rate, postoperative flatus time and hospital stay between the two groups（P〉0.05）. But the operation time and laparotomy rate were significantly shorter in HALS as compared TI~ （P〈0.05）. Conclusion The operation of hand-assisted laparoscopic splenectomy plus portal-azygous disconnection would retain the minimally invasive advantages, but also reduced the difficulty of surgery. It was safety and reliable, worthy of clinical application.