腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压效果观察

Laparoscopic megasplenectomy combined with pericardial devascularization in the treatment of cirrhosis with portal hypertension

目的:探讨腹腔镜下行巨脾切除联合贲门周围血管离断手术治疗肝硬化门静脉高压的效果。方法:2017年2月-2018年7月选取行巨脾切除联合贲门周围血管离断术的肝硬化门静脉高压患者54例,随机分为开腹手术组和腹腔镜手术组各27例。比较两组患者术中出血和预后情况。结果:两组患者手术时间、术中出血量比较,差异无统计学意义(P>0.05)。腹腔镜手术组平均肛门排气时间、拔除引流管时间、恢复饮食时间以及下床活动时间较开腹治疗组明显缩短,腹腔镜手术组术后并发症发生率低于开腹组,差异均有统计学意义(P<0.05)。结论:在腹腔镜下为肝硬化门静脉高压症患者行巨脾切除联合贲门周围血管离断手术治疗安全性较开腹方式更佳,患者术后恢复快,术后不良反应小。

Objective:To explore the effect of laparoscopic megasplenectomy combined with pericardial devascularization in the treatment of cirrhosis with portal hypertension.Methods:54 patients with cirrhosis and portal hypertension who underwent splenectomy and pericardial devascularization were selected from February 2017 to July 2018,they were randomly divided into the open operation group and the laparoscopic operation group with 27 cases in each group.We compared the intraoperative hemorrhage and prognosis between the two groups.Results:There was no significant difference between the two groups in operation time and bleeding volume(P>0.05).The average anal exhaust time,drainage tube removal time,diet recovery time and out of bed activity time in the laparoscopic operation group were significantly shorter than those in the open operation group,the complication rate of the laparoscopic operation group was lower than that of the open operation group,the differences were statistically significant(P<0.05).Conclusion:Laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhosis and portal hypertension is safer than open surgery.The patients recover quickly and have less adverse reactions.