完全腹腔镜巨脾切除术治疗肝硬化门静脉高压症合并巨脾的效果

Effect of Complete Laparoscopic Giant Splenectomy on Cirrhotic Portal Hypertension Complicated with Giant Spleen

目的:分析完全腹腔镜巨脾切除术治疗肝硬化门静脉高压症合并巨脾的效果。方法:选取2019年1月—2023年6月临沂市中医医院收治的肝硬化门静脉高压症合并巨脾患者60例为研究对象,根据单双数法分为对照组和观察组,各30例。对照组行开腹巨脾切除术,观察组行完全腹腔镜巨脾切除术。比较两组手术指标、术后恢复指标及并发症发生率。结果:观察组切口长度短于对照组,术中出血量少于对照组,住院费用高于对照组,差异有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);观察组术后24 h视觉模拟评分法评分低于对照组,术后拔管时间、肠功能恢复时间、住院时间短于对照组,差异有统计学意义(P<0.001);观察组并发症发生率低于对照组,差异有统计学意义(P=0.015)。结论:与传统开腹巨脾切除术相比,完全腹腔镜巨脾切除术治疗肝硬化门静脉高压症合并巨脾的优势显著,切口小、术中出血量少,不会增加手术时间,且有利于术后恢复,减轻疼痛,减少并发症,但也存在住院费用高的问题。

Objective:To analyze the effect of complete laparoscopic giant splenectomy in the treatment of cirrhotic portal hypertension complicated with giant spleen.Methods:Sixty patients with cirrhosis portal hypertension combined with giant spleen admitted to Linyi Hospital of Traditional Chinese Medicine from January 2019 to June 2023 were selected as the study objects,and were divided into control group and observation group according to odd-even number method,with thirty cases in each group.The control group underwent open giant splenectomy,the observation group underwent complete laparoscopic giant splenectomy.The operative index,postoperative recovery index and complication rate were compared between the two groups.Results:The incision length of observation group was shorter than that of control group,the amount of intraoperative blood loss was less than that of control group,and the hospitalization cost was higher,the difference was statistically significant(P<0.05);there was no significant difference in operation time between the two groups(P>0.05);the score of Visual Analogue Scale of observation group at 24 h after surgery was lower than that of control group,and the postoperative extubation time,intestinal function recovery time and hospital stay were shorter than that of control group,the difference was statistically significant(P<0.001);the complication rate of the observation group was lower than that of the control group,and the difference was statistically significant(P=0.015).Conclusion:Compared with traditional open giant splenectomy,complete laparoscopic giant splenectomy has significant advantages in the treatment of portal hypertension with cirrhosis combined with giant splenectomy.It has small incision,less intraoperative blood loss,no increase in operation time,and is conducive to postoperative recovery,pain relief and complications.However,it also has the problem of high hospitalization cost.