摘要
目的探讨完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的可行性、有效性和安全性。方法对26例患者行巨脾切除联合贲门周围血管离断术，其中16例行完全腹腔镜下二级脾蒂离断法脾切除联合贲门周围血管离断术，10例行传统开腹手术。比较两组的手术时间、术中出血量、术后并发症发生率、术后外周血血小板数值及术后住院时间等。结果腹腔镜组成功完成手术12例，中转开腹4例。腹腔镜组与开腹组平均手术时间分别为（315±77）rain和（291±31）min，两组相比差异无统计学意义，t=0．892，P=0．384；术中平均出血量分别为（409±216）ml和（980±402）ml，两组相比差异有统计学意义，t=4．105，P〈0．01；术后并发症发生率分别为17％和30％，两组相比差异无统计学意义，X2=0．064，P=0．525；术后平均住院时间分别为（10±3）d和（17士8）d，两组相比差异有统计学意义，t=2．539，P〈0．01。结论完全腹腔镜下巨脾切除联合贲门周围血管离断术安全、可行、有效，具有出血少、痛苦小、术后住院时间短的优点，是一种值得推广的微创手术。
Objective To evaluate the feasibility, effectiveness and safety of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension in cirrhotic patients. Methods In this study 16 cases underwent initial totally laparoscopic splenectomy and paraesophagogastric devascularization, with 10 cases undergoing upfront open surgery as controls by one treatment group. Clinical data including operative time, intraoperative blood loss, post-operative complications and hospitalization were compared between the two groups. Results In the laparoscopic group the procedure was successfully performed in 12 cases. 4 cases were converted to open surgery. The operative time in laparoscopic group and the open group was respectively （315 ±77 ） rain and （291± 31 ） min （ P = 0. 384）. The mean intro-operative blood loss was （409 ±216 ） ml and （ 980 ±402） ml （P 〈 0. 01 ）. The post-operative stay was （ 10 ±3 ） d and （ 17± 8 ） d （ P 〈 0. 01 ）. Differences in post-operative complication rate between the two groups was not statistically significant （ 17% vs. 30%, P = 0. 525 ）. Conclusions Laparoscopic splenectomy and pericardial devascularization is feasible, effective and safe for cirrhotic patients with portal hypertension, it has the advantage of less intra-operative blood loss,less pain and shorter hospitalization than open surgery.
出处
《中华普通外科杂志》
CSCD
北大核心
2012年第5期353-356,共4页
Chinese Journal of General Surgery
关键词
肝硬化
高血压
门静脉
腹腔镜
脾切除术
断流术
Liver cirrhosis
Hypertension, portal
Laparoscopes
Splenectomy
Devascularization
