脾切除贲门周围血管离断术治疗肝硬化门静脉高压症疗效观察

Observation on the effect of splenectomy plus pericardial devascularization in the treatment of cirrhotic portal hypertension

目的观察脾切除贲门周围血管离断术(SPD)治疗肝硬化门静脉高压症(PHT)的效果及对患者血流循环和血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)的影响。方法选择贵港市人民医院肝胆胰外科2020年5月—2024年4月诊治的116例肝硬化PHT患者进行回顾性分析,根据患者手术方式不同分为研究组(61例)和对照组(55例),研究组予腹腔镜下SPD治疗,对照组予开腹SPD治疗。比较两组治疗前后肝功能、血流循环、血常规和血清IL-6、TNF-α水平,并统计术后并发症情况。结果研究组第1天引流量与对照组相比差异无统计学意义(P>0.05),而术后胃肠道恢复时间、引流管拔除时间、手术时间、出血量及住院时间均短于对照组(P<0.05);术后1个月,相比于术前两组患者总胆红素(TBIL)、谷丙转氨酶(ALT)和凝血酶时间(PT)水平均下降,白蛋白(ALB)水平则升高,且研究组的TBIL、ALT、PT水平更低,ALB水平更高(P<0.05);术后门静脉、脾静脉的静脉直径(VD)、血流量(VF)较术前减小,流速(VV)水平较术前升高,且研究组VD、VF更小,VV水平更高(P<0.05);术后白细胞计数(WBC)、血小板计数(PLT)水平均较术前升高,且研究组相较于对照组更高(P<0.05)。两组患者术后7 d、1个月血清IL-6、TNF-α水平均较术前降低,且研究组降低幅度大于对照组(P<0.05);术后对照组并发症总发生率显著高于研究组(P<0.05)。结论腹腔镜SPD术式相比于开腹SPD术式,可减少肝硬化PHT患者术中出血量及术后并发症,有利于改善患者肝功能及血流动力学,降低IL-6、TNF-α水平。

Objective To study the curative effect of splenectomy plus pericardial devascularization(SPD)on cirrhotic portal hypertension(PHT)and its influence on liver function,blood circulation,serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α).Methods A total of 116 patients with cirrhotic PHT treated in the Department of Hepatobiliary and Pancreatic Surgery of Guigang People's Hospital from May 2020 to April 2024 were enrolled for retrospective analysis.According to different surgical methods,they were divided into study group(61 cases)and control group(55 cases).The study group were given laparoscopic SPD,while the control group were given open SPD.And then,liver functions,blood circulations,blood routines,and the levels of serum IL-6 and TNF-αbefore and after treatment were compared between the two groups,and postoperative complications were statistically analyzed.Results On the first day,there was no statistically significant difference in the drainage volume between the study group and the control group(P>0.05),while the postoperative gastrointestinal recovery time,drainage tube removal time,surgical time,bleeding volume,and hospitalization time of the study group were all shorter than those in the control group(P<0.05).Compared with those before treatment,the levels of total bilirubin(TBIL),alanine aminotransferase(ALT),and thrombin time(PT)in both groups decreased,but albumin(ALB)levels increased on one month after surgery,and the TBIL,ALT,PT levels in the study group were lower,while the ALB levels were higher(P<0.05).After surgery,the venous diameter(VD)and blood flow(VF)of the portal vein and splenic vein decreased compared to those before surgery,while the flow velocity(VV)levels increased.In addition,the VD and VF in the study group were smaller,and the VV levels were higher(P<0.05).After surgery,the levels of white blood cell count(WBC)and platelet count(PLT)increased compared to those before surgery,and the study group had higher levels than the control group(P<0.05).The serum levels of IL-6 and TNF-αin both groups decreased compared to those before surgery at 7 days and 1 month after surgery,and the decrease in the study group was greater than that in the control group(P<0.05).The total incidence of postoperative complications in the control group was significantly higher than that in the study group(P<0.05).Conclusion Compared with open SPD,laparoscopic SPD can reduce intraoperative blood loss and postoperative complications in patients with cirrhotic PHT,which is beneficial to improve liver functions and hemodynamics,and reduce IL-6 and TNF-αlevels.