门脉高压症合并胆囊结石同期行脾切除门奇断流加胆囊切除术的临床分析(附56例报告)

Clinical analysis of combined operation of splenectomy plus portozygos disconnection with cholecystectomy for cholecystolithiasis patients with portal hypertension:with a report of 56 cases

目的:探讨门脉高压症合并胆囊结石同期行脾切除门奇断流加胆囊切除术的可行性、安全性及手术技巧。方法:回顾分析2013年1月至2017年10月为56例门脉高压症合并胆囊结石患者同期行脾切除门奇断流加胆囊切除术的临床资料,其中21例行开腹手术(开腹组),35例行腹腔镜手术(腹腔镜组)。对比分析两组手术时间、术中出血量、术后进食时间、术后排气时间、术后拔除引流管时间、术后住院时间及术后并发症发生率等相关指标。结果:56例均顺利完成手术。腹腔镜组术中出血量、术后进食时间、术后排气时间、术后拔除引流管时间及术后住院时间明显优于开腹组(P<0.01);术后均未出现严重并发症,患者痊愈出院。结论:门脉高压症合并胆囊结石同期行脾切除门奇断流加胆囊切除术,严格掌握手术适应证,术中优先阻断处理脾动脉,结合娴熟的手术技巧,尽管手术风险大,但是安全、可行的,腹腔镜手术可作为首选术式。

Objective：To evaluate the feasibility,safety and surgical techniques of combined operation of splenectomy plus portozygos disconnection with cholecystectomy for cholecystolithiasis patients with portal hypertension. Methods： The clinical data of 56 cholecystolithiasis patients with portal hypertension who underwent combined operation of splenectomy plus portozygos disconnection with cholecystectomy from Jan. 2013 to Oct. 2017 were retrospectively analyzed. 21 patients underwent laparotomy（ open group）,35 patients underwent laparoscopic surgery（ laparoscopic group）. The operative time,blood loss,time of postoperative feeding,exhaust,postoperative drainage tube removal,postoperative hospital stay and postoperative complications incidence were compared and analyzed. Results：All of the 56 patients were successfully performed combined operation of splenectomy plus portozygos disconnection with cholecystectomy. The blood loss,time of postoperative feeding,exhaust,postoperative drainage tube removal and postoperative hospital stay in laparoscopic group were all less than those in open group（ P〈0. 01）. There were no serious complications,and all patients were cured and discharged from hospital. Conclusions：It is safe and feasible to carry out the combined operation of splenectomy plus portozygos disconnection with cholecystectomy for cholecystolithiasis patients with portal hypertension when the indications are strictly controlled,the splenic artery is firstly ligated and the operative technique is adeptly performed. With the development of laparoscopic instruments and surgical techniques,this laparoscopic procedure should be regarded as principal choice in treatment of the cholecystolithiasis patients with portal hypertension.