腹腔镜与开腹脾切断流术的临床对比研究

目的比较腹腔镜脾脏切除术（LS）加贲门周围血管离断术（ED）同开腹脾脏切除术（OS）加贲rJ周围血管离断术对于治疗伴有难治性静脉曲张破裂出血的门脉高压症患者的疗效及安全性。方法回顾性分析2002年1月至2012年7月期间内，77例行OSED术以及同期67例行LSED术治疗的门脉高压症患者的临床资料及并发症情况。结果LSED组的手术时间和OSED组之间无明显差别（P=0．757）。LSED组术中出血，术后胃肠功能恢复时间明显少于OSED组（P〈0．001，P=0．019）。术后LSED组ALT、AST以及TBIL三项指标明显低于OSED组（P=0．002，P=0．002，P=0．015）。术后PLT、WBC以及H11检查结果两组之间无叫显差别（P=0．786，P=0．056，P=0．973）。术后并发症LSED组门静脉系统血栓发生率高十OSED组（P=0．037），其余并发症两组之间无显著差异。结论LSED术在治疗伴有难治性食管胃底静脉曲张出血的门脉高压症时具有安全、有效以及创伤小的特点。

A clinical comparative study between LSED and OSED for portal hypertension

Objective Aim To compare the safety and efficacy between laparoscopic spleneetomy and esophagogastric devaseularization （LSED） and open spleneetomy and esophagogastric devascularization （OSED） in treating portal hypertension with refi＇actory variceal bleeding. Methods A retrospective analysis of clinical data and complications of 77 patients received OSED surgery and over the same period 67 patients received LSED surgery whom diagnosed of portal hypertension in our hospital from 2002.1 2012.7. Results The LSED group operation time and OSED groups had no significant difference （P=-0.757）. The LSED group blood loss, postoperative gastrointestinal function recovery time was significantly less than OSED group （P〈 0.001,P=0.019）. The LSED group postoperative lab data ALT, AST and TBIL was significantly lower than OSED group （P=0.002,P=0.002,P=0.015）. No significant difference in postoperative PLT, WBC and Hb between the two groups （P=0.786, P=0.056, P=-0.973）. The incidence of portal vein system thrombosis as the complications of the LSED group was higher than the OSED group, the other complications between the two groups had no significant difference. Conclusion The LSED surgery has the advantages of safe, less surgery trauma and effective in treating portal hypertension associated with reffctory variceal bleeding.