腹腔镜辅助脾切除联合门奇断流术40例的临床分析

Clinical analysis of hand-assisted laparoscopic splenectomy combined with Minch devascularization:report of 40 cases

目的探讨手辅助腹腔镜脾切除术联合门奇断流术的临床价值,为临床提供参考。方法选自2008年1月至2014年7月于住院治疗的肝硬化合并脾大、门静脉高压的患者80例,采用随机数表法分为两组每组40例,实验组采用手辅助腹腔镜脾切除术联合门奇断流术,对照组行传统开腹手术。选择Spss18.0进行数据统计,手术时间、术中出血量、术后当天疼痛评分和术后恢复情况用均数±标准差(x珋±s)表示,采用t检验,并发症发生率比较采用χ2检验,P<0.05差异具有统计学意义。结果实验组患者手术时间、术中出血量和术后当天疼痛评分、术后引流时间、总引流量、肛门排气和住院时间均低于对照组,两组之间差异均具统计学意义(P<0.05)。两组患者术后应激反应:实验组患者的IL-6、TNF-α、CRP水平分别为(2.1±1.5)pg/L、(230.7±90.3)pg/L、(1.2±1.4)mg/L,均低于对照组(4.9±1.3)pg/L、(387.2±108.5)pg/L、(2.7±1.3)mg/L,差异均具统计学意义(P<0.05)。术后实验组患者的并发症发生率5.0%,明显低于对照组20.0%,两组比较有统计学意义(P<0.05)。结论手辅助腹腔镜脾切除联合门奇静脉断流术明显优于传统手术方式,具有临床推广价值。

Objective To assess the clinical value of hand-assisted laparoscopic splenectomy combined with Minch devascularization. Methods Eighty patients with liver cirrhosis, splenomegaly and portal hypertension treated from January 2008 to July 2014 were randomly divided into two groups. The experimental group （40 patients ） underwent hand-assisted laparoscopic splenectomy combined Mineh devascularization, and the control group （40 patients） underwent conventional open surgery. Statistical data were analyzed using SPSS 18. 0 software. Operative time, blood loss, postoperative pain scores, and postoperative day recovery were expressed as mean ± standard deviation and compared by Student＇s t test. The incidences of complications of both groups were compared by the Chi-square test ; P 〈 0.05 was considered statistically significant. Results In the experimental group, operative time, blood loss and postoperative pain scores were higher than those in the control group （P 〈 0.05 ）. IL-6, TNF-α and CRP levels [（2.1 ± 1.5） pg/L, （230.7± 90.3 ） pg/L, and （ 1.2 ± 1.4） mg/L respectively] in the experimental group were lower than those [ （4.9 ±1.3 ） pg/L, （387.2 ± 108.5） pg/L, and （2.7 ± 1.3 ） mg/L respectively I in the control group. The rate of postoperative complications in the experimental group （ 5.0% ） was significantly lower than that in the eontrol group （20.0%） （ P 〈 0.05 ）. Conclusions Hand-assisted laparoscopic splenectomy combined Minch devascularization is better than the traditional surgical approach in clinical practice.