脾床入路腹腔镜脾切除联合贲门周围血管离断术的疗效评价

Laparoscopic splenectomy via spleen bed in combination with esophagogastric devascularization for the treatment of portal hypertension

目的评估脾床入路联合直线切割闭合器腹腔镜脾切除贲门周围血管离断术治疗肝硬化门静脉高压症的可行性与安全性。方法回顾性分析2012年6月至2016年7月河南省人民医院行脾切除贲门周围血管离断术肝硬化门静脉高压症患者390例，分为腹腔镜组145例，开腹组245例。结果腹腔镜组和开腹组的术中失血量相比差异无统计学意义（P〉0．05）。腹腔镜组手术时间长于开腹组[（279±104）min比（188±68）min，t=5．361，P〈0．01]，住院时间和经口进食时间较开腹组短[（11±5）d比（15±6）d，t=7．501，P〈0．01）；（3．3±0．8）d比（3．7±0．9）d，t=2．731，P〈0．01]。两组患者术后肝功能相比差异无统计学意义（P〉0．05）。两组术后并发症如门静脉血栓形成、胰漏、胸腔积液、血小板〉800×10。／L相比差异均无统计学意义（均P〉0．05）。开腹组腹水量和发热发生率高于腹腔镜组（P〈0．05）。结论脾床人路联合直线切割闭合器腹腔镜脾切除贲门周围血管离断术治疗肝硬化门静脉高压症是安全可行的。

Objective To evaluate the feasibility and safety of laparoscopic splenectomy and esophagogastric devascularization （LSPD） via spleen bed using endoscopic linear stapler （Echelon Flex 60 Endopath） versus open splenectomy and esophagogastric devascularization （OSPD） for cirrhotic portal hypertension. Methods A total of 390 patients suffering from liver cirrhosis and portal hypertension operated in our department from Jun 2012 to Jul 2016 were divided into two groups ： 145 for LSPD and 245 for OSPD. Characteristics, clinical data and postoperative complications were compared. Results There were no significant differences in estimated intraoperative blood loss between LSPD and OSPD groups. The operation time of LSPD group was longer than OSPD group. However, the time of hospital stay and time of oral intake were shorter in the LSPD group than the OSPD group （ P 〈 0. 05 ）. No significant differences were detected for liver function such as ALT, AST, T-BIL and ALB after operation, nor in the rate of postoperative complications between the 2 groups such as portal vein thrombosis, pancreatic leakage, pleural effusion and PLT 〉800×10^9/L. But amount of ascites and fever （ 〉38.0℃, 〉3 d） in OSPD group was higher than LSPD group （P 〈0. 05）. Conclusions LSPD via spleen bed combined with endoscopic linear stapler for liver cirrhosis and portal hypertension is a safe and feasible procedure.