腹腔镜巨脾切除治疗肝硬化门静脉高压的效果观察

Clinical effect of laparoscopic splenectomy in the treatment of liver cirrhotic portal hypertension

目的探究腹腔镜巨脾切除治疗肝硬化门静脉高压的效果。方法回顾性分析2016年7月至2019年7月66例肝硬化门静脉高压合并巨脾患者的临床资料,根据术式不同分为开腹组和腹腔镜组,每组各33例。采用统计软件SPSS 21.0进行分析,围术期指标、肝功能指标、门静脉系统血流动力学指标采用(±s)表示,行独立t检验;术后并发症行χ^2检验;P<0.05差异有统计学意义。结果(1)腹腔镜组在术中出血量、胃肠道恢复蠕动时间、引流量和住院时长方面均少于开腹组(P<0.05);腹腔镜组术时较开腹组长(P<0.05);(2)腹腔镜并发症总发生率低于开腹组(24.2%vs.54.5%),P<0.05;(3)腹腔镜组术后2周肝功能改善且优于开腹组(P<0.05);(4)术后2周两组患者门静脉系统血流直径、流速及流量较术前改善(P<0.05)。结论腹腔镜巨脾切除治疗肝硬化门静脉高压术中出血少,术后恢复快,并发症少,近期疗效好,安全可行,值得推广。

Objective To explore the clinical effect of laparoscopic splenectomy in the treatment of liver cirrhotic portal hypertension.Methods 66 patients with cirrhotic portal hypertension in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to the different operative methods,they were divided into the laparoscopic group and the open group with 33 cases in each group.Statistical software SPSS 21.0 was used for data analysis.Perioperative indicators,postoperative complications and liver function indicators were observed and compared between the two groups.Results(1)Laparoscopic group was superior to open group in terms of intraoperative bleeding volume,gastrointestinal peristalsis recovery time,drainage volume and length of hospital stay(P<0.05),and the operation time of open group were shorter than the laparoscopic group(P<0.05).(2)The complication incidence of the laparoscopic group was lower(24.2%vs.54.5%)than that of the open group(P<0.05).(3)The improvement of liver function in laparoscopic group was better than that in open group on 2 weeks after operation(P<0.05).(4)Two weeks after operation,the diameter,velocity and flow of portal vein system in two groups were better than that in one day before operation(P<0.05).Conclusion Laparoscopic splenectomy has the advantages of less bleeding,faster recovery,less incidence of complications,good short-term curative effect,safety and feasibility,and is worthy of promotion in the treatment of liver cirrhotic portal hypertension.