完全3D腹腔镜与开腹手术治疗门脉高压症的对比研究

Comparative study of total 3D laparoscopic and open surgery in the treatment of portal hypertension

目的:探讨完全3D腹腔镜下脾切除及贲门周围血管离断术治疗门脉高压症的手术疗效及可行性。方法:2013年1月至2016年3月43例患者因肝硬化引起的门脉高压、脾大及食管胃底静脉曲张行完全3D腹腔镜脾切除术及贲门周围血管离断术(腹腔镜组),同期41例患者行开腹手术(开腹组),对比分析两组患者术中、术后情况。结果:腹腔镜组手术时间长于开腹组(P<0.05),腹腔镜组术中出血量、术后排气时间、术后住院时间、切口长度、止痛剂使用次数优于开腹组(P<0.05),在术后并发症方面,腹腔镜组腹腔积液、切口感染率低于开腹组(P<0.05),腹腔出血、肺部感染、胰瘘、胃瘘、门静脉血栓形成、围手术期死亡与开腹组相比差异无统计学意义(P>0.05)。结论:完全3D腹腔镜行脾切除及贲门周围血管离断术具有术中出血少、术后胃肠功能恢复快、住院时间短、术后并发症发生率低等优点,完全3D腹腔镜手术治疗门脉高压症是安全、有效、可行的。

Objective： To explore the efficacy and feasibility of total 3D laparoscopic splenectomy and pericardial devascularization in the treatment of portal hypertension. Methods： From Jan. 2013 to Mar. 2016,43 patients underwent total 3D laparoscopic splenectomy and pericardial devascularization for portal hypertension,splenomegaly and esophageal and gastric fundus varices caused by cirrhosis and 41 patients underwent laparotomy due to the same cause at the same time. The intraoperative and postoperative indexes of laparoscopic group and open group were compared and analyzed. Results： The operating time of the laparoscopic group was more than that of the laparotomy group （P 〈 0. 05）. The intraoperative blood loss,time to first postoperative flatus,hospital stay,length of incision,uses of analgesics of laparoscopic group were less than those of laparotomy group （P 〈 0. 05）. The incidence of peritoneal effusion and incision infection of the laparoscopic group was less than that of laparotomy group （P〈 0. 05）. There were no significant differences in abdominal bleeding,pulmonary infection,pancreatic fistula,gastric fistula,portal vein thrombosis,perioperative mortality between the 2 groups （P 〉 0. 05）. Conclusions： Total 3D laparoscopic splenectomy and pericardial devascularization has the advantages of less blood loss during operation,faster postoperative recovery of gastrointestinal function,shorter hospital stay,and fewer incidence of postoperative complications. Total 3D laparoscopic surgery in the treatment of portal hypertension is safe,effective and feasible.