腹腔镜下脾切除术联合贲门周围血管离断术治疗肝硬化门静脉高压的效果观察

Clinical effect of laparoscopic splenectomy combined with esophagogastric devascularization in treatment of liver cirrhosis with portal hypertension

目的探讨腹腔镜下脾切除术（LS）联合贲门周围血管离断术（ED）治疗食管胃底静脉曲张出血及重度脾功能亢进的有效性和安全性。方法回顾性分析2012年6月-2013年6月于汉中市中心医院就诊的肝硬化门静脉高压患者68例,分为LS＋ED组和开腹脾切除术（OS）＋ED组各34例。对比两组患者临床指标、并发症、手术前后胃底静脉曲张程度及肝功能Child-Pugh评分变化。计量资料组间比较采用t检验,计数资料组间比较采用χ~2检验或Fisher确切概率法。结果在术中出血量、术后引流量、术后住院时间和术后肛门排气时间方面,LS＋ED组明显少于OS＋ED组（t值分别为-3.144、-2.536、-4.151、-2.671,P值分别为0.003、0.015、0.001、0.002）,在食管胃底静脉曲张程度及肝功能Child-Pugh评分改善方面二者差异均无统计学意义（P值均〉0.05）。结论 LS＋ED可以明显降低患者术中出血量、术后引流量、术后肛门排气时间和术后住院天数等,是一种安全、可行、有效的门静脉高压症的治疗方法。

Objective To investigate the effect and safety of laparoscopic splenectomy（ LS） combined with esophagogastric devascularization（ ED） in the treatment of esophagogastric variceal bleeding and severe hypersplenism. Methods A retrospective analysis was performed for 68 patients with cirrhotic portal hypertension who visited The Central Hospital of Hanzhong from June 2012 to June 2013. The patients were divided into LS ＋ ED group and open splenectomy（ OS） ＋ ED group,with 34 patients in each group. The clinical indices,complications,degree of gastric varices before and after surgery,and changes in Child- Pugh score for liver function were compared between the two groups. The t- test was used for comparison of continuous data between groups,and the chi- square test or the Fisher＇s exact test was used for comparison of categorical data between groups. Results The LS ＋ ED group had a significantly lower postoperative drainage volume,significantly less intraoperative blood loss,a significantly shorter length of postoperative hospital stay,and a significantly shorter postoperative ventilation time than the OS ＋ ED group（ t =- 3. 144,- 2. 536,- 4. 151,and- 2. 671,P = 0. 003,0. 015,0. 001,and 0. 002）,while the improvements in the degree of gastric varices and Child- Pugh score for liver function showed no significant differences between the two groups（ both P 0. 05）. Conclusion LS combined with ED can significantly reduce intraoperative blood loss,postoperative drainage volume,time of passage of gas by anus after surgery,and length of postoperative hospital stay,and therefore,it is a safe,feasible,and effective method for the treatment of portal hypertension.