腹腔镜脾脏切除术治疗肝硬化所致脾功能亢进

Study on laparoscopic splenectomy for hypersplenism caused by liver cirrhosis

目的：探讨腹腔镜脾脏切除术治疗肝硬化门脉高压引起的脾功能亢进的临床疗效。方法选取因肝硬化门脉高压引起的脾功能亢进而行脾脏切除术患者38例，其中行开腹脾脏切除术（ OS组）18例，行腹腔镜脾脏切除术（ LS组）20例。回顾性分析两组手术时间、术中出血量、住院时间、术后T管拔出时间、肝肾功能、血常规、引流液淀粉酶等指标。结果与术前比较，LS组ALT术后2 d内、术后3～6 d均显著降低（t＝6．75、9．32，均P＜0．05）；LS组术后3～6 d AST水平显著降低（t＝8．87，P＜0．05）；LS组术后2 d内、术后3～6 d GGT水平均显著低于术前（t＝6．54、10．76，均P＜0．05）。 LS组术后BUN下降，与术前差异有统计学意义（t＝3．43，P＜0．05），术后3～6 d及术后7～9 d，LS组白细胞、血小板及血红蛋白改善均优于OS组（t＝19．32、10．21、8．42、6．76、9．32、13．32，均P＜0．05）。结论 LS对肝硬化脾脏功能亢进的治疗方面效果更佳，值得推广应用。

Objective To explore the clinical effect of laparoscopic splenectomy caused by liver cirrhosis portal hypertension .Methods 38 patients treated with splenectomy as a result of hypersplenism induced by liver cir-rhosis portal hypertensions were selected .Laparotomy splenectomy was used in 18 cases （ OS group ） , laparoscopic splenectomy was used in 20 cases（LS group）.Operation time , amount of bleeding during operation ,duration of hos-pital stays,liver and kidney function,blood routine,AYM were retrospectively analyzed.Results Compared with the preoperative group,LS ALT 2D after operation,postoperative 3-6d were significantly decreased（t=6.75,9.32,all P〈0.05）;3-6d AST levels after operation in LS group significantly decreased （t=8.87,P〈0.05）;LS group 2D after operation,postoperative 3-6d GGT levels were significantly lower than that of the preoperative （t=6.54,10.76, all P〈0.05）;group LS patients urea nitrogen levels falling postoperation ,there was statistically significant difference （t=3.43,P〈0.05）,leukocyte levels,PLT and HBG in the two groups increased postoperation ,these were statistical-ly significant difference（t=19.32,10.21,8.42,6.76,9.32,13.32,all P〈0.05）,OS group increased more obvious-ly.Conclusion LS has a better treatment effect on hypersplenism caused by liver cirrhosis ,which is worthy of popu-larization and application .