手助腹腔镜巨脾切除联合贲门食管血管离断术的临床疗效分析

Clinical efficacy of hand-assisted laparoscopic giant splenectomy combined with cardia-esophageal devascularization

目的:探讨手助腹腔镜巨脾切除联合贲门食管血管离断术的临床疗效。方法:回顾分析2015年1月至2023年1月为52例患者行脾切除联合贲门食管周围血管离断术的临床资料,根据手术方式分为腔镜组(行完全腹腔镜手术,n=18)、手助组(行手助腹腔镜手术,n=11)与开腹组(n=23),对比分析三组患者一般资料、手术疗效及术后并发症。结果:3组患者年龄、性别、入院血常规、Child-Pugh分级等一般资料差异无统计学意义(P>0.05)。手助组脾脏最大径大于腔镜组(P<0.001)。手助组手术时间、术后排气时间、术后住院时间短于开腹组(P<0.01),与腔镜组相比差异无统计学意义(P>0.05)。手助组术中出血量少于腔镜组与开腹组(P<0.01)。腔镜组、手助组及开腹组术后并发症发生率分别为16.7%、9.1%与34.8%,差异无统计学意义(P=0.182)。3组术后腹腔出血、胰瘘等并发症发生率差异无统计学意义(P>0.05)。结论:为巨型脾脏患者行手辅助腹腔镜脾切除联合贲门食管周围血管离断术不会增加手术风险及术后并发症,且具有创伤小、康复快等微创优势,值得临床推广。

Objective:To investigate the clinical efficacy of hand-assisted laparoscopic giant splenectomy combined with cardia-esophageal devascularization.Methods:Clinical data of 52 patients who underwent laparoscopic splenectomy combined with cardia-e sophageal devascularization from Jan.2015 to Jan.2023 were retrospectively analyzed.According to different surgical methods,patients were divided into three groups,including 18 cases in complete laparoscopic group,11 cases in hand-assisted laparoscopic group and 23 cases in laparotomy group.The patients'general data,surgical efficacy and postoperative complications were compared among the three groups.Results:There were no significant differences in the age,gender,admission blood routine,Child-Pugh classification and so on in the three groups(P>0.05).The spleen's maximum diameter of the hand-assisted laparoscopic group was significantly greater than that of the complete laparoscopic group(P<0.001).The operation time,postoperative exhaust time and postoperative hospital stay of the hand-assisted laparoscopic group were significantly shorter than those of the laparotomy group(P<0.01),there were no statistical differences between the complete laparoscopic group and hand-assisted laparoscopic group(P>0.05).In terms of intraoperative blood loss,the hand-assisted laparoscopic group was significantly less than the complete laparoscopic group and laparotomy group(P<0.01).The postoperative complication rates were 16.7%,9.1%and 34.8%in the complete laparoscopic group,hand-assisted laparoscopic group and laparotomy group respectively,there was no significantly statistical difference(P=0.182).In addition,there was no statistical difference in the incidence of complications such as abdominal hemorrhage and pancreatic fistula among the three groups(P>0.05).Conclusions:The hand-assisted laparoscopic splenectomy combined with cardia-esophageal devascularization does not increase the operative risk and the incidence of postoperative complications for patients with giant spleen.It has the advantages of minimal invasion and rapid rehabilitation,and is worthy of clinical promotion.