门静脉高压症的微创手术治疗经验

Laparoscopic esophagogastric devascularization for portal hypertension

目的探讨腹腔镜脾切除贲门周围血管离断术联合加速康复外科在门静脉高压症患者治疗中的应用价值。方法收集2013年1月至2018年1月空军军医大学第二附属医院行脾切除贲门周围血管离断术205例门静脉高压症患者的临床资料,其中135例行腹腔镜脾切除贲门周围血管离断术(腹腔镜组),70例行开腹脾切除贲门周围血管离断术(开腹组)。结果腹腔镜组患者手术时间、术中出血量、术中输血量、术后腹腔引流管拔除时间、术后胃肠功能恢复时间、术后住院时间分别为(150±37)min.(223±129)1111.(91±138)ml、(4.0±1.O)d、(33±9)h、(5.6±1.0)d,开腹组分别为(183±42)min、(346±131)ml、(214±182)ml、(5.5±1.3)d、(42±14)h、(7.5±1.4)d,两组相比差异均有统计学意义(t=-2.203,-4.980,-2.830,-5.553,-2.307,-6.635,均P<0.05)。主要并发症有胰漏、腹腔出血、腹腔感染、肺部感染、难治性腹水、门静脉系统血栓、切口感染,腹腔镜组分别为0、1、2、2、3、13、0例,开腹组分别为3、4、6、6、7、14、3例,两组比较差异均有统计学意义(X^2=5.872、4.792、6.179.6.179.6.010.4.335.5.872,均P<0.05)。205例患者均获得随访,中位随访时间为38个月。所有患者术后6个月时复査胃镜显示食管胃底静脉曲张减轻或消失。结论腹腔镜脾切除贲门周围血管离断术治疗门静脉高压症是安全可行的、有效的。

Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension.Methods In this study,205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group)and 70 patients undergoing open surgery(OSD group).Results Operation time,intraoperative blood loss,intraoperative blood infusion,time of postoperative abdominal drainage-tube removal,time of gastrointestinal function recovery and duration of hospital stay were respectively(150±37)min,(223±129)ml,(91±138)ml,(4.0±1.0)d,(33±9)h,(5.6±1.0)d in the LSD group,(183±42)min,(346±131)ml,(214±182)ml,(5.5±1.3)d,(42±14)h,(7.5±1.4)d in the OSD group,with statistically significant differences between groups(t=-2.203,-4.980,-2.830,一5.553,-2.307,-6.635,all P<0.05).The main complications included pancreatic fistula,intra-abdominal bleeding,intra-abdominal infection,pulmonary infection,refractory ascites,portal vein system thrombosis and incision infection,and there were respectively 0,1,2,2,3,13,0 in the LSD group and 3,4,6,6,7,14,3 in the OSD group,with statistically significant differences between groups(X^2=5.872,4.792,6.179,6.179,6.010,4.335,5.872,all P<0.05).All the 205 patients received follow-up for a median time of 38 months(12-72 months).Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months.Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe,feasible and effective.