摘要
目的探讨完全腹腔镜贲门周围血管离断术联合脾切除术治疗肝硬化门静脉高压症(CPH)的临床疗效。方法纳入2016年6月~2019年10月间收治的140例CPH患者作为研究对象,采用随机数表法分为观察组和对照组,每组各70例。观察组患者采用完全腹腔镜贲门周围血管离断术联合脾切除术,对照组采用开腹贲门周围血管离断术联合脾切除术。比较两组围术期状况(术中出血量、手术时间、术后下床时间、术后住院时间),评估患者术前、术后1周肝功能谷丙转氨酶(ALT)、谷草转氨酶(AST)、评估患者术前、术后1天、术后1周时血清炎症因子C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6),随访3个月记录两组术后并发症发生率,观察术后1年远期随访结果。结果观察组较对照组术中出血量少、手术时间长、术后下床时间及术后住院时间短(P<0.05);术后1周时,两组ALT、AST均低于术前(P<0.05),观察组与对照组组间对比差异无统计学意义(P>0.05);术前、术后1天及术后1周时,两组CRP、TNF-α、IL-6均上升后降低(P<0.05),观察组术后1天及术后1周时CRP、TNF-α、IL-6水平均低于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05);两组再发上消化出血、死亡率对比差异均无统计学意义(P>0.05)。结论完全腹腔镜贲门周围血管离断术联合脾切除术有利于改善患者围术期情况,降低其血清炎症因子水平和术后并发症发生率。
Objective To explore the clinical efficacy of complete laparoscopic pericardial devascularization combined with splenectomy in the treatment of cirrhotic portal hypertension(CPH).Methods 140 CPH patients admitted between June 2016 and October 2019 were included as study subjects and divided into observation group and control group,according to the random number table method,with 70 cases in each group.Observation group was given complete laparoscopic pericardial devascularization combined with splenectomy,and control group was given open pericardial devascularization combined with splenectomy.The perioperative status(intraoperative blood loss,operative time,postoperative ambulation time,postoperative hospital stay)were compared between the two groups.The liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST)]was evaluated before operation and at 1 w after operation,and the serum inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]were evaluated before operation and at 1 d and 1w after operation.The incidence rate of postoperative complications was recorded in the two groups at 3 months of follow-up,and the long-term follow-up results were observed at 1 year after operation.Results Compared with control group,the intraoperative blood loss was less(P<0.05),and the operative time was longer(P<0.05),and the postoperative ambulation and postoperative hospital stay were shorter(P<0.05)in observation group.At 1w after operation,the ALT and AST in the two groups were lower than those before operation(P<0.05),and there were no significant differences between observation group and control group(P>0.05).Before operation and at 1 d and 1w after operation,the levels of CRP,TNF-αand IL-6 in the two groups was first increased and then decreased(P<0.05),and the levels of CRP,TNF-αand IL-6 in observation group were lower than those in control group at 1 d after operation and at 1 w after operation(P<0.05).The incidence rate of complications in observation group was lower than that in control group(P<0.05).There were no significant differences in the recurrent digestive bleeding rate and mortality rate between the two groups(P>0.05).ConclusionComplete laparoscopic pericardial devascularization combined with splenectomy is beneficial to improve perioperative conditions,reduce serum inflammatory factors levels and incidence rate of postoperative complications.
作者
尕藏东周
喻定刚
罗斯满
陈见中
唐正勇
Gazangdongzhou;YU Dinggang;LUO Siman;CHEN Jianzhong;TANG Zhengyong(The Second Department of Surgery, The People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Maerkang 624000, Sichuan, China)
出处
《西部医学》
2021年第1期111-114,119,共5页
Medical Journal of West China
