改良脾动脉栓塞联合腹腔镜脾切除术治疗患者门脉高压继发脾大伴脾功能亢进

Modified splenic arterial embolization plus laparoscopic splenectomy in the management of patients with splenomegaly and hypersplenism secondary to portal hypertension

目的探讨改良脾动脉栓塞（SAE）联合腹腔镜脾切除术（LS）治疗门脉高压继发脾大伴脾功能亢进的安全性和有效性。方法回顾性分析2012年4月至2015年12月第三军医大学新桥医院收治的54例门脉高压继发脾大伴脾功能亢进患者的临床资料。其中改良脾动脉栓塞联合Ls组（SAE＋Ls组）24例，单纯Ls组30例，比较两组患者手术治疗效果。计量资料采用t检验，计数资料采用）（2检验。结果改良脾动脉栓塞联合Ls组手术均获得成功，无中转开腹患者。Ls组有6例中转开腹手术。与Ls组相比，SAE＋Ls组手术时间短[（150±29）rain比（210±40）min，t=-6．098，P〈0．05）]、术中出血少[（168±58）ml比（314±87）ml，t=-6．981，P〈0．05）]、术后住院时间短[（5．5±0．6）d比（7．6±1．3）d，t=-6．797，P〈0．05）]，差异有统计学意义。在术后并发症发生率、术后肠道功能恢复时间、开始进食及离床活动时间等方面两组差异无统计学意义（P〉0．05）。结论对于通常被认为是Ls相对禁忌的门脉高压继发脾大伴脾功能亢进，采用改良脾动脉栓塞联合LS治疗是安全、有效的。

Objective To investigate the safety and effectiveness of modified splenic arterial embolization （SAE） plus laparoscopic splenectomy （LS） in patients with splenomegaly and hypersplenism secondary to portal hypertension. Methods The clinical data of 54 patients with splenomegaly and hypersplenism secondary to portal hypertension admitted to the Xinqiao Hospital of the Third Military Medical University from April 2012 to December 2015 were collected and retrospectively analyzed. 24 patients underwent modified splenic arterial embolization plus LS （ the SAE ± LS group）, and 30 patients underwent LS alone （the LS group）. The postoperative surgical outcomes between the two groups were compared. Continuous data were analyzed using the t test, and categorical data were analyzed using the Chi-square test. Results The modified splenic arterial embolization plus LS was performed successfully in all the patients in the SAE ± LS group, and no patient required open surgery. Six patients in the LS group were converted to laparoto- my. A shorter operative time [ （ 150 ± 29） rain vs. （210 ± 40） min, t = - 6. 098, P 〈 0.05 ], less intrao- perative blood loss [ （ 168 ± 58） ml vs. （314 ± 87） ml, t = - 6. 981, P 〈 0.05 ], and shorter postopera- tive hospitalization stay [（5.5 ± 0.6） dvs. （7.6 ± 1.3） d, t= -6.797, P〈0.05] in theSAE-LS group were observed when compared with the LS group. There were no significant differences in postoperative complication rates, postoperative gastrointestinal function recovery, oral intake and off-bed activity times between the two groups. Conclusion The modified splenic arterial embolization plus LS was safer and more effective in treating splenomegaly and hypersplenism secondary to portal hypertension than LS alone.