腹腔镜脾切除联合内镜食管静脉套扎术与联合贲门周围血管离断术治疗门静脉高压症的效果比较

Comparison of effects of laparoscopic splenectomy combined with endoscopic esophageal variceal ligation and laparoscopic splenectomy combined with pericardial devascularization in treatment of portal hypertension

目的:比较腹腔镜脾切除联合内镜食管曲张静脉套扎术与联合贲门周围血管离断术治疗门静脉高压症的效果。方法:回顾性分析2009年3月至2016年1月的46例乙肝后肝硬化门静脉高压症手术患者的临床资料,根据手术方法将患者分为套扎术组25例和离断术组21例,套扎术组患者采用腹腔镜脾切除联合内镜食管曲张静脉套扎术,离断术组患者采用腹腔镜脾切除联合贲门周围血管离断术。比较两组患者术中出血量、术后肛门排气时间、术后血浆管引流总量、手术时间和术后住院时间等临床相关指标,C反应蛋白、血小板和血白细胞等血清学指标,Child-Pugh评分及MELD评分等肝脏储备功能及并发症发生情况。结果:套扎术组患者术中出血量明显少于离断术组,术后肛门排气时间、术后血浆管引流总量、手术时间及术后住院时间均明显短于离断术组,差异有统计学意义(P<0.05);术后第1、3天,套扎术组CRP水平均明显低于离断术组,差异有统计学意义(P<0.05);术后2周,两组血小板和白细胞计数均明显高于术前(P<0.05),但组间差异无统计学意义(P>0.05);术后2周及术后6个月,两组Child-Pugh评分及MELD评分均明显低于术前(P<0.05),但组间差异无统计学意义(P>0.05);套扎术组患者并发症发生率为16.00%(4/25),明显低于离断术组的85.71%(18/21),差异有统计学意义(P<0.05)。结论:腹腔镜脾切除联合内镜食管曲张静脉套扎术治疗门静脉高压症的效果优于腹腔镜脾切除联合贲门周围血管离断术治疗效果。

Objective:To compare effects of laparoscopic splenectomy combined with endoscopic variceal ligation and laparoscopic splenectomy combined with pericardial devascularization in treatment of portal hypertension.Methods:46 patients with portal hypertension due to liver cirrhosis after hepatitis B were selected and their general data were analyzed retrospectively.According to different treatment methods,these patients were divided into two groups:ligation group(25 cases)and devascularization group(21 cases).Laparoscopic splenectomy combined with endoscopic variceal ligation was used in the ligation group,while laparoscopic splenectomy combined with pericardial devascularization was used in the devascularization group.The blood loss during the operation,anal exhaust time after the operation,total amount of plasma tube drainage after the operation,operation time and hospital stay after the operation,the serological indexes such as C-reactive protein,platelets and white blood cells,Child-Pug score,MELD score,liver reserve function and complications were compared between the two groups.Results:The blood loss during the operation in the ligature group was significantly less than that in the devascularization group;the anal exhaust time after the operation,total amount of plasma tube drainage after the operation,operation time and hospital stay after the operation were significantly less or shorter than those in the devascularization group;and the differences were statistically significant(P<0.05).On the 1st and 3rd day after the operation,the CRP levels in the ligation group were significantly lower than those in the devascularization group,and the differences were statistically significant(P<0.05).At the 2nd week after the operation,the platelet and leukocyte counts in the two groups were significantly higher than those before the operation,and the differences were statistically significant(P<0.05).Moreover,there were no statistically significant differences between the two groups(P >0.05).2 weeks and 6 months after the operation,the Child-Pugh scores and MELD scores of the two groups were significantly lower than those before the operation,and the differences were statistically significant(P<0.05).Also,there were no significant differences between the two groups(P >0.05).The incidence of complications in the ligation group was 16.00%(4/25),which was significantly lower than that in the devascularization group(85.71%,18/21),and the difference was statistically significant(P<0.05).Conclusions:Laparoscopic splenectomy combined with endoscopic variceal ligation in the treatment of portal hypertension is superior to laparoscopic splenectomy combined with pericardial devascularization.