改良的腹腔镜下脾切除加贲门周围血管离断术并发症的防治

The prevention and treatment for the complications of modified laparoscopic splenectomy and pericardial devascularization

目的探讨改良的腹腔镜下脾切除加贲门周围血管离断术治疗肝硬化合并门静脉高压性上消化道出血及脾亢患者的并发症防治及其临床价值。方法回顾性分析扬州大学临床医学院2010年1月至2013年3月同期分别接受改良的腹腔镜下脾切除加贲门周围血管离断术（腹腔镜组）及开腹脾切除加贲门周围血管离断术（开腹组）的110例肝硬化性门静脉高压患者的临床资料，其中腹腔镜组39例，开腹组71例，将两组的手术情况、术后恢复情况和并发症进行比较。结果腹腔镜组的手术时间为（221±60）min，明显长于开腹组的手术时间（175±34）min（t=4．408，P〈0．01）；腹腔镜组术中失血量为（190±167）ml，显著少于开腹组的（327±244）ml（t=-3．471，P〈0．01）；腹腔镜组术后住院天数为（10．4±2．2）d，显著少于开腹组的（15．8±4．3）d（t=-8．729，P〈0．01）。腹腔镜组的术后并发症1例，开腹组的术后并发症17例（X2=8．407，P〈0．01）。结论改良的腹腔镜下脾切除加贲门周围血管离断术是安全可行的，患者创伤小、并发症少、术后恢复快。

Objective To explore the prevention and treatment for the complications of modified laparoscopic splenectomy and pericardial devascularization for cirrhotic patients with bleeding portal hypertension and secondary hypersplenism. Methods A total of 110 cirrhotic patients with bleeding portal hypertension and secondary hypersplenism undergoing modified laparoseopie splenectomy and pericardial devascularization or open procedures between January 2011 and March 2013 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group （ LAP, n = 39） and open group （ OPEN, n = 71 ）. Operative time,blood loss, postoperative hospital stay and complications were compared between the two groups. Results Compared to that in open group, operative time in the LAP group was longer E （221 ＋ 60） minvs. （175~34） min, t=4.408,P〈0.01], blood loss was less E（190 ~167） ml vs. （327 ~ 244） ml,t = - 3.471,P 〈 0.01 ], postoperative hospital stay shorter E （ 10.4 ~ 2. 2） d vs. （ 15.8 ~ 4. 3 ） d, t= -8.729,P 〈 0.01], and complications less （1 case vs. 17 cases, X2 = 8.407, P 〈 0.01）. Conclusions Modified laparoscopic splenectomy and perieardial devaseularization for cirrhotic patients with bleeding portal hypertension and secondary hypersplenism is safe. Complications are less, and recovery are faster.