BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outco...BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.展开更多
目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸...目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸转氨酶(alanine transaminase,ALT)、总胆红素、凝血酶原时间、白蛋白、肝动脉血流、门静脉血流、吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 min,ICGR15)和吲哚菁绿最大清除率(indocyanine green maximum removal rate,ICGRmax)的变化情况。结果术前和术后第3、6个月LV分别为(844.47±80.25)、(1010.07±92.08)、(1050.91±98.79)cm^(3),差异有统计学意义(F=47.695,P=0.000),其中术后第3、6个月LV明显大于术前(均P=0.000),术后第6个月LV显著大于术后第3个月(P=0.016)。术前和术后第3、6个月ALT中位数分别为80(13~235)、29(11~71)、26(11~73)U/L,差异有统计学意义(χ^(2)=28.894,P=0.000),其中术后第3、6个月ALT明显低于术前(均P=0.000)。术前和术后第3、6个月ICGR15分别为(24.12±7.37)%、(18.31±4.59)%、(17.50±4.11)%,术前后差异有统计学意义(F=14.642,P=0.000),其中术后第3、6个月ICGR15明显低于术前(均P=0.000)。术前和术后第3、6个月ICGRmax分别为(1.48±0.18)、(1.60±0.14)、(1.62±0.15)mg·kg^(-1)·min^(-1),差异有统计学意义(F=14.353,P=0.000),其中术后第3、6个月ICGRmax明显高于术前(均P=0.000)。术前和术后第3、6个月肝动脉血流分别为(186.76±21.59)、(352.66±18.58)、(357.27±25.72)ml/min,术前后差异有统计学意义(F=609.171,P=0.000),术后第3、6个月明显高于术前(均P=0.000)。术前和术后第3、6个月门静脉血流分别为(1870.80±244.21)、(1205.37±212.68)、(1183.05±225.80)ml/min,术前后差异有统计学意义(F=110.020,P=0.000),其中术后第3、6个月明显低于术前(均P=0.000)。术前后总胆红素、凝血酶原时间、白蛋白差异无统计学意义(P>0.05)。结论腹腔镜脾切除联合选择性贲门周围血管断流术可改善肝脏供血,促进肝脏再生,改善患者肝脏功能。展开更多
基金The study was reviewed and approved by the Chinese PLA General Hospital Institutional Review Board(Approval No.2010068D).
文摘BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.
文摘目的探讨腹腔镜脾切除联合选择性贲门周围血管断流术前后肝功能及肝脏体积(liver volume,LV)的变化。方法选择2015年1月~2019年8月我院腹腔镜脾切除联合选择性贲门周围血管断流术治疗肝硬化门静脉高压症31例,观察患者术前后LV、丙氨酸转氨酶(alanine transaminase,ALT)、总胆红素、凝血酶原时间、白蛋白、肝动脉血流、门静脉血流、吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 min,ICGR15)和吲哚菁绿最大清除率(indocyanine green maximum removal rate,ICGRmax)的变化情况。结果术前和术后第3、6个月LV分别为(844.47±80.25)、(1010.07±92.08)、(1050.91±98.79)cm^(3),差异有统计学意义(F=47.695,P=0.000),其中术后第3、6个月LV明显大于术前(均P=0.000),术后第6个月LV显著大于术后第3个月(P=0.016)。术前和术后第3、6个月ALT中位数分别为80(13~235)、29(11~71)、26(11~73)U/L,差异有统计学意义(χ^(2)=28.894,P=0.000),其中术后第3、6个月ALT明显低于术前(均P=0.000)。术前和术后第3、6个月ICGR15分别为(24.12±7.37)%、(18.31±4.59)%、(17.50±4.11)%,术前后差异有统计学意义(F=14.642,P=0.000),其中术后第3、6个月ICGR15明显低于术前(均P=0.000)。术前和术后第3、6个月ICGRmax分别为(1.48±0.18)、(1.60±0.14)、(1.62±0.15)mg·kg^(-1)·min^(-1),差异有统计学意义(F=14.353,P=0.000),其中术后第3、6个月ICGRmax明显高于术前(均P=0.000)。术前和术后第3、6个月肝动脉血流分别为(186.76±21.59)、(352.66±18.58)、(357.27±25.72)ml/min,术前后差异有统计学意义(F=609.171,P=0.000),术后第3、6个月明显高于术前(均P=0.000)。术前和术后第3、6个月门静脉血流分别为(1870.80±244.21)、(1205.37±212.68)、(1183.05±225.80)ml/min,术前后差异有统计学意义(F=110.020,P=0.000),其中术后第3、6个月明显低于术前(均P=0.000)。术前后总胆红素、凝血酶原时间、白蛋白差异无统计学意义(P>0.05)。结论腹腔镜脾切除联合选择性贲门周围血管断流术可改善肝脏供血,促进肝脏再生,改善患者肝脏功能。
