腹腔镜与开腹脾切除术对肝硬化继发性脾功能亢进治疗效果的对比研究

A comparative study of laparoscopic and open splenectomy in the treatment of secondary hypersplenism due to liver cirrhosis

目的:比较腹腔镜脾脏切除术(LS)和开腹脾切除术(OS)治疗肝硬化继发性脾功能亢进患者的效果。方法:2015年1月-2019年12月收治肝硬化继发性脾功能亢进患者113例,分为两组。A组实施LS治疗;B组实施OS治疗。比较两组临床效果。结果:A组中转开腹率为25.8%;两组术后白细胞、血小板、血红蛋白、总胆红素、谷丙转氨酶及谷草转氨酶等指标水平比较,差异无统计学意义(P>0.05);A组术后住院时间和引流管放置时间均低于B组,但A组住院费用、手术出血量和手术时间均高于B组,差异有统计学意义(P<0.05);同时,A组术中输血率也明显高于B组。结论:针对肝硬化继发性脾功能亢患者,LS确实是一种有效、痛苦较少的手术,但是手术风险依然较高;与传统的OS相比,LS的安全性和患者收益尚值得商榷。

Objective:To compare the effects of laparoscopic splenectomy(LS)and open splenectomy(OS)in the treatment of patients with secondary hypersplenism due to liver cirrhosis.Methods:From January 2015 to December 2019,113 patients with secondary hypersplenism due to liver cirrhosis were selected,they were were divided into the two groups.The group A was treated with LS.The group B was treated with OS.We compared the clinical effects of the two groups.Results:The conversion rate to laparotomy in the group A was 25.8%.There was no significant difference in the levels of white blood cells,platelets,hemoglobin,total bilirubin,alanine aminotransferase and aspartate aminotransferase between the two groups after surgery(P>0.05).The postoperative hospital stay and drainage tube placement time in the group A were lower than those in the group B,but the hospitalization cost,surgical blood loss and operation time in the group A were higher than those in the group B,the differences were statistically significant(P<0.05).At the same time,the intraoperative blood transfusion rate in the group A was also significantly higher than that in the group B.Conclusion:For patients with secondary hypersplenism due to liver cirrhosis,LS is indeed an effective and less painful surgery,but the risk of surgery is still higher.Compared with traditional OS,the safety and patient benefits are still questionable.