腹腔镜断流联合食管静脉套扎与开腹术治疗门静脉高压患者临床效果对比分析

Comparison of clinical effect of laparoscopic esophageal variceal ligation and devascularization with laparotomy for the treatment of portal hypertension

目的对比分析腹腔镜断流联合食管静脉套扎与开腹术治疗门静脉高压患者的临床效果。方法根据随机数字表法将87例门静脉高压患者随机分为A组(n=45)和B组(n=42)。A组采用腹腔镜断流联合食管静脉套扎治疗,B组采用开腹术治疗。对比分析两组食管胃底静脉曲张程度、手术时间、术后肛门排气时间、术后住院时间、肝功能Child-Pugh分级、门静脉血流量、肝动脉阻力指数、肝动脉峰值流速。结果 A组食管胃底静脉曲张程度术后6个月改善显著优于B组,且具有统计学差异(P<0.05);A组手术时间、术后肛门排气时间及术后住院时间均显著短于B组,术中出血量显著少于B组,且均具有统计学差异(P<0.05);两组术后6个月肝功能A级患者显著多于各组间术前,B级患者显著少于各组间术前,且均具有统计学差异(P<0.05);而两组间比较不具有统计学差异(P>0.05);两组术后15 d肝动脉峰值流速显著高于术前,而门静脉血流量、肝动脉阻力指数显著低于术前(P<0.05);A组术后15 d门静脉血流量、肝动脉阻力指数显著低于B组,且均具有统计学差异(P<0.05);而两组间肝动脉峰值流速比较不具有统计学差异(P>0.05)。结论腹腔镜断流联合食管静脉套扎治疗门静脉高压患者效果优于开腹术。

Objective To compare the clinical effect of laparoscopic esophageal variceal ligation（ EVL）and devascularization with lapa-rotomy for patients with portal hypertension. Methods According to the random number table,87 cases were randomly divided into group A（ n =45）and group B（n=42）. Group A treated with laparoscopic EVL and devascularization,group B treated with laparotomy. The items com-pared between two groups were as follows：esophageal and gastric varices,operative time,postoperative exhaust time and hospital stay,Child-Pugh classification,portal blood flow,hepatic artery resistance index and peak velocity. Results Compared with group B,in group A,esophage-al and gastric varices degree six months after surgery was better improved（ P 〈0. 05）,the operative time,postoperative exhaust time and hospital stay were shorter,blood loss was less（ P 〈0. 05）. Six months postoperation,patients with Child-Pugh classification grade A were increased, and patients with grade B was decreased in both groups when compared with those before surgery（ P 〈0. 05）;but no difference between the two groups（ P 〉0. 05）. Fifteen days postoperation,portal blood flow and hepatic arterial resistance index were decreased,and hepatic artery peak velocity was increased than those before surgery in both groups（ P 〈0. 05）;however,portal blood flow and hepatic artery resistance index was significantly lower in group A than in group B（ P 〈0. 05）;but no difference in hepatic artery peak velocity between two groups（ P 〉0. 05）. Conclusion The combination of laparoscopic EVL and devascularization is more effective than open surgery for the treatment of portal hypertension.