腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压并发食管胃底静脉曲张患者疗效研究

Laparoscopic splenectomy and pericardial devascularization in treatment of cirrhotics with esophageal varice and its impact on portal hemodynamics

目的 比较采用腹腔镜脾切除联合贲门周围血管离断术与开腹手术治疗肝硬化门静脉高压症并发食管胃底静脉曲张(EV)患者的疗效及对门脉血流动力学的影响。方法 2016年3月~2021年3月我科诊治的45例肝硬化门静脉高压症患者,其中20例接受开腹脾切除联合贲门周围血管离断术,另25例接受腹腔镜脾切除联合贲门周围血管离断术治疗。采用放射免疫分析法检测血浆内皮素(ET)、血管紧张素Ⅱ(ATⅡ)和肾素活度(PRA),使用多普勒超声诊断仪测量门静脉血流量(PVF)、门静脉血流流速(PVV)、门静脉直径(PVD)和肝动脉血流量(HAF)。结果 腹腔镜组手术时间、术中出血量、术中输血量、术后引流管拔除时间、术后排气时间和拆线时间分别为(213.5±20.7)min、(362.8±56.9)ml、(312.5±20.7)ml、(3.8±0.6)d、(2.7±0.4)d和(7.9±1.5)d,与开腹组【分别为(188.4±16.9)min、(415.2±50.7)ml、(349.4±23.6)ml、(5.1±0.9)d、(3.2±0.5)d和(11.3±2.1)d】比,差异显著(P<0.05);术后1 m,腹腔镜组PVF、PVV、PVD和HAF分别为(871.3±91.5)ml/min、(41.5±3.8)cm/s、(1.0±0.2)cm和(872.2±29.7)ml/min,与开腹组【分别为(904.7±87.3)ml/min、(39.7±3.4)cm/s、(1.1±0.2)cm和(881.6±30.5)ml/min】比,无显著性差异(P>0.05);术后6 m,两组肝功能指标比较,无显著性差异(P>0.05);腔镜组血浆ET、ATⅡ和PRA水平分别为(74.7±5.1)ng/L、(143.3±7.6)ng/L和(71.5±7.9)ng/L,与开腹组【分别为(76.5±6.3)ng/L、(146.7±9.6)ng/L和(73.4±7.6)ng/L,P>0.05】比,无显著性差异。结论 采取腹腔镜下脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压并发EV患者可达到与开腹手术相同的疗效,对门脉血流动力学的影响与开腹手术也相差不大。

Objective The aim of this study was to compare the laparoscopic and open splenectomy and pericardial devascularization in treatment of cirrhotics with esophageal varice(EV) and its impact on portal hemodynamics. Methods 45 cirrhotic patients with EV were enrolled in our hospital between March 2016 and March 2021, and 20 patients received open and another 25 patients received laparoscopic splenectomy and pericardial devascularization. Plasma endothelin(ET), angiotensin II(ATII) and plasma renin activity(PRA) were detected by radioimmunoassay. The portal vein flow(PVF), portal vein velocity(PVV), portal vein diameter(PVD) and hepatic arterial flow(HAF) were measured by Doppler ultrasonography. Results The operation time, intraoperative blood loss, blood transfusion volume, removal of drainage tube, postoperative exhaust and suture removal in patients receiving laparoscopic surgery were(213.5±20.7)min,(362.8±56.9)ml,(312.5±20.7)ml,(3.8±0.6)d,(2.7±0.4)d and(7.9±1.5)d, significantly different as compared to [(188.4±16.9)min,(415.2±50.7)ml,(349.4±23.6)ml,(5.1±0.9)d,(3.2±0.5)d and(11.3±2.1)d, respectively, P<0.05] in patients receiving open operation;at the end of one month after operation, the PVF, PVV, PVD and HAF in laparoscopic surgery-treated patients were(871.3±91.5)ml/min,(41.5±3.8)cm/s,(1.0±0.2)cm and(872.2±29.7) ml/min, not significantly different compared to [(904.7±87.3)ml/min,(39.7±3.4)cm/s,(1.1±0.2)cm and(881.6±30.5)ml/min, P>0.05] in open operation-treated patients;at the end of six months after surgery, there were no significant differences respect to liver function tests between the two groups(P>0.05);plasma ET, ATⅡ and PRA in laparoscopic surgery-treated patients were(74.7±5.1)ng/L,(143.3±7.6)ng/L and(71.5±7.9)ng/L, not significantly different compared to [(76.5±6.3)ng/L,(146.7±9.6)ng/L and(73.4±7.6)ng/L, respectively, P>0.05] in open operation-treated patients. Conclusion The laparoscopic splenectomy and pericardial devascularization might obtain the same efficacy of open operation in cirrhotics with EV, and the portal hemodynamics after operation is getting smooth.