Clinical effect of laparoscopic splenectomy combined with esophagogastric devascularization in treatment of liver cirrhosis with portal hypertension
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摘要: 目的探讨腹腔镜下脾切除术(LS)联合贲门周围血管离断术(ED)治疗食管胃底静脉曲张出血及重度脾功能亢进的有效性和安全性。方法回顾性分析2012年6月-2013年6月于汉中市中心医院就诊的肝硬化门静脉高压患者68例,分为LS+ED组和开腹脾切除术(OS)+ED组各34例。对比两组患者临床指标、并发症、手术前后胃底静脉曲张程度及肝功能Child-Pugh评分变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验或Fisher确切概率法。结果在术中出血量、术后引流量、术后住院时间和术后肛门排气时间方面,LS+ED组明显少于OS+ED组(t值分别为-3.144、-2.536、-4.151、-2.671,P值分别为0.003、0.015、0.001、0.002),在食管胃底静脉曲张程度及肝功能Child-Pugh评分改善方面二者差异均无统计学意义(P值均>0.05)。结论 LS+ED可以明显降低患者术中出血量、术后引流量、术后肛门排气时间和术后住院天数等,是一种安全、可行、有效的门静脉高压症的治疗方法。Abstract: Objective To investigate the effect and safety of laparoscopic splenectomy( LS) combined with esophagogastric devascularization( ED) in the treatment of esophagogastric variceal bleeding and severe hypersplenism. Methods A retrospective analysis was performed for 68 patients with cirrhotic portal hypertension who visited The Central Hospital of Hanzhong from June 2012 to June 2013. The patients were divided into LS + ED group and open splenectomy( OS) + ED group,with 34 patients in each group. The clinical indices,complications,degree of gastric varices before and after surgery,and changes in Child- Pugh score for liver function were compared between the two groups. The t- test was used for comparison of continuous data between groups,and the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results The LS + ED group had a significantly lower postoperative drainage volume,significantly less intraoperative blood loss,a significantly shorter length of postoperative hospital stay,and a significantly shorter postoperative ventilation time than the OS + ED group( t =- 3. 144,- 2. 536,- 4. 151,and- 2. 671,P = 0. 003,0. 015,0. 001,and 0. 002),while the improvements in the degree of gastric varices and Child- Pugh score for liver function showed no significant differences between the two groups( both P > 0. 05). Conclusion LS combined with ED can significantly reduce intraoperative blood loss,postoperative drainage volume,time of passage of gas by anus after surgery,and length of postoperative hospital stay,and therefore,it is a safe,feasible,and effective method for the treatment of portal hypertension.
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Key words:
- liver cirrhosis /
- hypertension,portal /
- laparoscopy /
- splenectomy /
- esophagogastric devascularization
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[1]NI YB,GAO PJ,WANG D,et al.Esophagogastric devascularization without splenectomy in portal hypertension:safe and effective?[J].Hepatobiliary Pancreat Dis Int,2015,14(3):276-280. [2]HAN K,KIM JH,KO GY,et al.Treatment of hepatocellular carcinoma with portal venous tumor thrombosis:a comprehensive review[J].World J Gastroenterol,2016,22(1):407. [3] SCHETTINI AV,PINHEIRO RS,PESCATORE P,et al.Modified sugiura operation for idiopathic portal hypertension with bleeding oesophageal varices.A case report[J].Acta Chir Belg,2014,115(3):237-240. [4]CHENG Z,LI J,CHEN J,et al.Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases[J].J Laparoendosc Adv Surg Tech A,2014,24(9):612-616. [5]JIANG XZ,ZHAO SY,LUO H,et al.Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension[J].World J Gastroenterol,2009,15(27):3421. [6]ALEXAKIS N,DARDAMANIS D,ALBANOPOULOS K,et al.Incidence,risk factors,and outcome of portal vein thrombosis after laparoscopic-assisted splenectomy inβ-thalassemia patients:a prospective exploratory study[J].J Laparoendosc Adv Surg Tech A,2013,23(2):123-128. [7]CHEN GM,ZHANG Y.Advances in the application of various surgical procedures of laparoscopic splenectomy in treatment of portal hypertension[J].J Ningxia Med Univ,2015,37(6):721-724.(in Chinese)陈官明,张岩.不同腹腔镜脾脏切除手术方式在治疗门脉高压症中的应用进展[J].宁夏医科大学学报,2015,37(6):721-724. [8]HAMA T,TAKIFUJI K,UCHIYAMA K,et al.Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension[J].J Hepatobiliary Pancreat Surg,2008,15(3):304-309. [9]BAO HK,WEI XL.Comparisons of clinical effect of hand-assisted laparoscopic and open splenectomy combined with pericardial devascularization for the treatment of portal hypertension in liver cirrhosis[J].Clin J Med Offic,2015,43(12):92-94,97.(in Chinese)包汉康,韦秀丽.手助腹腔镜与开腹脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效比较[J].临床军医杂志,2015,43(12):92-94,97. [10]JANKULOVSKI N,ANTOVIC'S,PETRUEVSKA G,et al.Laparoscopic versus open splenectomy:a single center eleven-year experience[J].Acta Clinica Croatica,2013,52(2):229-234. [11]LYU JL,LI XP,YANG SW,et al.Laparoscopic splenectomy and pericardial devascularization for splenomegaly:a report of 15 cases[J].Chin J Mini Inv Surg,2013,13(5):406-408.(in Chinese)吕金利,李雪平,杨世伟,等.腹腔镜下巨脾切除联合贲门周围血管离断术15例[J].中国微创外科杂志,2013,13(5):406-408. [12]ZHENG X,DOU C,YAO Y,et al.A meta-analysis study of laparoscopic versus open splene ctomy with or without esophagogastric devascularization in the managemet of liver cirrhosis and portal hypertension[J].J Laparoendosc Adv Tech A,2015,25(2):103-111. [13]ZHANG Y,YANG HJ,DENG XF,et al.The effect of total laparoscopic splenectomy combined with endoscopic variceal ligation on portal hypertension in hepatitis B cirrhosis patients[J].Pract J Clin Med,2013,10(2):43-47.(in Chinese)张宇,杨洪吉,邓小凡,等.全腹腔镜脾切除联合经内镜食管曲张静脉套扎术与开腹断流术治疗门静脉高压症的临床对照研究[J].实用医院临床杂志,2013,10(2):43-47. [14]XU B,LIU N,XU JH.Hand-assisted laparoscopic splenectomy combined with pericardial devascularization for hepatic cirrhosis with portal hypertension[J].Chin J Gen Surg,2015,24(1):145-148.(in Chinese)许斌,刘妮,许建华.手助腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症[J].中国普通外科杂志,2015,24(1):145-148. [15]XU JW,ZHANG YM,SONG Y,et al.Laparoscopic splenectomy and pericardial devascularization for portal hypertension[J].Chin J Mini Inv Surg,2015,15(7):601-603.(in Chinese)徐继威,张耀明,宋越,等.完全腹腔镜下脾切除联合贲门周围血管离断术治疗门脉高压症[J].中国微创外科杂志,2015,15(7):601-603.
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