腹腔镜下脾切除术联合经内镜下套扎序贯硬化剂治疗对门静脉高压症病人的疗效及对其血流动力学及预后的影响

Analysis of clinical efficacy hemodynamic indexes and prognosis of laparoscopic splenectomy and EVLS therapy in the treatment ofportal hypertension patients

目的探讨腹腔镜下脾切除术联合经内镜下套扎序贯硬化剂(EVLS)治疗对肝门静脉高压症(PHT)病人的疗效及对其血流动力学及预后的影响。方法2015年8月~2018年1月收治PHT病人91例,根据治疗方式分为对照组(45例)和研究组(46例),其中对照组采用贲门周围血管离断术联合腹腔镜下脾切除治疗,研究组采用腹腔镜下脾切除术联合内镜下序贯套扎及硬化剂治疗,比较两组临床疗效等差异。结果术后研究组的术中出血量(241.1±82.0)ml、术后腹腔引流量(473.8±122.3)ml、术后肛门排气时间(2.1±0.5)天、清醒率为15.2%,术后住院时间为(11.3±2.2)天,对照组分别为(363.4±118.2)ml、(677.5±154.0)ml、(3.5±0.9)天、35.6%及(16.0±3.4)天,两组比较差异有统计学意义(P<0.05);术后研究组肿瘤坏死因子(TNF)-α为(38.1±9.3)ng/L,白细胞介素(IL)-6为(27.6±7.2)ng/L,C反应蛋白(CRP)为(41.6±11.2)mg/L,门静脉压(PVP)为(21.5±1.5)mmHg,门静脉血流速度(PVV)为(18.7±2.7)cm/s,门静脉内径(PVD)为(11.4±0.5)mm,门静脉血流量(PVF)为(535.7±90.6)ml/min,对照组分别为(73.0±11.1)ng/L、(40.3±4.4)ng/L,(68.4±12.0)mg/L,(25.4±1.8)mmHg,(19.4±3.0)cm/s,(13.2±0.6)mm,(739.4±93.8)ml/min,两组比较,差异有统计学意义(P<0.05);半年后,两组Child-Pugh评分和及MELD评分比较,差异无统计学意义(P>0.05)。结论腹腔镜下脾切除术联合EVLS治疗对门静脉高压症病人的疗效更佳,不仅可减轻病人的炎性反应,同时对其血流动力学影响较小,且不影响预后。

Objective To investigate the analysis of clinical efficacy、hemodynamic indexes and prognosis of laparoscopic splenectomy and Endoscopicvariceal ligation and sclerotherapy in the treatment of portal hypertension patients.Methods From August 2015 to January 2018,91 patients with PHT were admitted,according to the treatment were divided into control group(n=45)and group(n=46),the control group using cardiac blood vessels around from surgery combined therapy with laparoscopic splenectomy,the team used laparoscopic splenectomy in combination with endoscopic sequential ligation and hardener treatment,compared two groups of clinical curative effect.Results The intraoperative bleeding(241.1±82.0)ml,postoperative abdominal drainage(473.8±122.3)ml,postoperative anal venting time(2.1±0.5)d,awake rate(15.2%)and postoperative hospital stay(11.3±2.2)d in the study group were better than those in the control group[(363.4±118.2)ml,(677.5±154.0)ml,(3.5±0.9)d,35.6%and(16.0±3.4)d](P<0.05).The postoperative serum inflammatory indexes[TNF-α:(38.1±9.3)ng/L,IL-6:(27.6±7.2)ng/L and CRP:(41.6±11.2)mg/L]and hemodynamic parameters[PVP:(21.5±1.5)mmHg,PVV:(18.7±2.7)cm/s,PVD:(11.4±0.5)mm and PVF:(535.7±90.6)ml/min]compared with the control group[TNF-α:(73.0±11.1)ng/L,IL-6:(40.3±4.4)ng/L and CRP:(68.4±12.0)mg/L;PVP:(25.4±1.8)mmHg,PVV:(19.4±3.0)cm/s,PVD:(13.2±0.6)mm and PVF:(739.4±93.8)ml/min](P<0.05).After six months,there was not statistically significant in sithe Child-Pugh score compared with the two groups(P>0.05).Conclusion The laparoscopic splenectomy and EVLS therapy in the treatment of portal hypertension patients has a better therapeutic effect,which can not only reduce the inflammatory response of patients,but also have little influence on hemodynamics and prognosis.