腹腔镜与开腹脾切除贲门周围血管离断术治疗门静脉高压症的临床疗效分析

Clinical analysis of laparoscopy and open surgery on portal hypertension in pericardial devascularization and splenectomy

目的分析腹腔镜贲门周围血管离断术联合脾脏切除术治疗门静脉高压症的临床疗效。方法门静脉高压症病人48例,根据手术方式分为开腹组(开腹贲门周围血管离断术)和腔镜组(腹腔镜贲门周围血管离断术),每组24例,观察比较两组的临床疗效。结果腹腔镜组术后丙氨酸氨基转氨酶(alanine aminotransferase,ALT)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)下降幅度分别为45.00、35.59和25.79,开腹组分别为49.34、43.17和27.88,两组比较差异有统计学意义(P<0.05);腔镜组术后并发症总发生率为16.67%(4例),开腹组为58.33%(16例);腔镜组术后随访1年并发症总发生率为4.17%(1例),开腹组为29.17%(7例),两组比较差异有统计学意义(P<0.05)。结论腹腔镜贲门周围血管离断术治疗门静脉高压症,术后ALT、AST、TBIL恢复更快,术后并发症降低。

Objective To study the clinical effect of laparoscopic highly selective pericardial devascularization combined with splenectomy in the treatment of portal hypertension.Methods 48 patients with portal hypertension were divided into the laparotomy group(open pericardial devascularization)and the endoscopic group(Laparoscopic pericardia devascularization)according to the surgical methods.Each group had 24 patients,and the clinical efficacy of the two groups was observed and compared.Results After surgery,the decrease of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)in the laparoscopic group■、■、■was significantly greater than that of open surgery group■、■、■.The difference between the two groups was statistically significant(P<0.05).The overall complication rate in the laparoscopic surgery group(16.67%)was significantly lower than that of the open surgery group(58.33%).The patients were followed up for 1 year,the overall incidence of complication of laparoscopic surgery group(4.17%)was lower than that of open surgery group(29.17%),the difference was statistically significant(P<0.05).Conclusion Portal hypertension treated by laparoscopic pericardial devascularization with ALT,AST,TBIL recover faster,less postoperative complications,and better quality a life than pericardial devascularization.