腹腔镜联合胃镜治疗肝硬化门静脉高压症食管胃底静脉曲张破裂出血的疗效分析

Combined laparoscopic and gastroscopic treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophageal varices

目的评估腹腔镜脾切除联合贲门周围血管离断术联合胃镜治疗肝硬化门静脉高压症食管胃底静脉曲张破裂出血患者的疗效。方法回顾分析2013年3月至2018年3月连续在嘉兴市第一医院诊断为肝硬化门静脉高压症食管胃底静脉曲张破裂出血108例患者资料,其中男性61例,女性47例,平均年龄61岁。根据患者疾病情况及本人与家属意愿,单纯接受胃镜下治疗43例纳入胃镜组,腹腔镜脾切除联合贲门周围血管离断术28例纳入腹腔镜组,腹腔镜脾切除联合贲门周围血管离断术联合胃镜下治疗37例纳入双镜联合组。比较三组术后肝功能、肾功能、凝血功能、静脉曲张改善程度等,随访患者预后。结果双镜联合组术后肾功能和凝血功能优于其他两组,血红蛋白也优于其他两组,差异均有统计学意义(均P<0.05)。腹腔镜组术后36个月内再出血4例,胃镜组3例,双镜联合组无再出血。术后36个月复查胃镜,腹腔镜组轻度、中度、重度静脉曲张8例(28.6%)、9例(32.1%)、11例(39.3%),胃镜组7例(16.3%)、26例(60.5%)、10例(23.2%),双镜联合组32例(86.5%)、5例(13.5%)、0例。双镜联合组食管胃底静脉曲张程度改善明显优于腹腔镜组、胃镜组。结论双镜联合治疗肝硬化门静脉高压症食管胃底静脉曲张破裂出血患者疗效尚可,再出血率低,有临床推广应用前景。

Objective To evaluate the efficacy of laparoscopic splenectomy plus pericardial devascularization combined with gastroscopic(double endoscopy)treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophagogastric varices.Methods To retrospectively analyze 108 patients who presented with bleeding esophageal and gastric varices at the First Hospital of Jiaxing from March 2013 to March 2018.Of 108 patients,there were 61 males and 47 females,with an average age of 61 years.According to the disease and desires of patients and family members,28 patients underwent laparoscopic splenectomy plus devascularization(the laparoscopic group),43 endoscopic treatment(the endoscopic group)and 37 double endoscopic treatment(the double endoscopic group).The liver function,renal function,hemoagglutination and degrees of recurrence of the three groups were compared after operation.Results The renal function,coagulation function,HbA1c in the double endoscopic group was significantly better than that in the other two groups(P<0.05).In the laparoscopic group,there were 4 patients who presented with rebleeding within 36 months,compared with 3 in the endoscopic group,and no patients in the combined group.At 36 months after operation,gastroscopy performed in the laparoscopic group showed mild varices in 8(28.6%)patients,moderate in 9(32.1%),and severe in 11(39.3%).In the endoscopic group,there were 7(16.3%)patients with mild,26(60.5%)with moderate,and 10(23.2%)with severe.In the double endoscopic group,there were 32(86.5%)patients with mild and 5(13.5%)with moderate.The degrees of recurrence and postoperative esophageal and gastric varices rebleeding in the double endoscopic group were significantly better than those in the laparoscopic group and the endoscopic group(P<0.05).Conclusion Laparoscopic combined with endoscopic treatment was more effective in patients with cirrhosis and portal hypertension who presented with bleeding esophageal varices.