脾切除术联合门奇静脉断流术治疗肝硬化门脉高压症患者疗效研究*

目的 研究腹腔镜门奇静脉断流术联合脾切除术治疗肝硬化门脉高压症合并巨脾患者的效果。方法 2016年12月～2018年12月我院收治的86例肝硬化并发门脉高压症合并巨脾患者被分为两组,每组43例,其中对照组行开腹,而观察组实施腹腔镜下门奇静脉断流术联合脾切除术。结果 观察组术中出血量为(180.8±23.1)ml,显著少于对照组的【(286.4±35.7)ml,P<0.05】,术后住院日为(6.0±1.3)d,显著短于对照组的【(8.6±1.5)d,P<0.05】;观察组术后7 d外周血WBC为(8.9±1.4)×10⁹/L,PLC为(132.0±28.9)×10⁹/L,对照组分别为(7.2±1.8)×10⁹/L,PLC为(125.6±30.3)×10⁹/L,均较术前显著升高(P<0.05);观察组术后门静脉直径为(1.2±0.1)cm,血流量为(911.7±261.7)ml/min,对照组分别为(1.2±0.2)cm,血流量为(888.5±191.5)ml/min,均较术前显著缩小或下降(P<0.05);观察组术后并发症发生率为9.3%,显著低于对照组的37.2%(P＜0.05)。结论 腹腔镜下门奇静脉断流术联合脾切除术治疗肝硬化门脉高压症合并巨脾患者临床疗效确切,创伤小,术后并发症发生率低,恢复快。

Efficacy of laparoscopic portal-azygos vein devascularization and splenectomy in treatment of patients with cirrhotic portal hypertension

Objective The aim of this study was to investigate the efficacy of laparoscopic portal-azygos vein devascularization and splenectomy in treatment of patients withcirrhotic portal hypertension.Methods 86 patients with cirrhotic portal hypertension complicated with megaspleen were enrolled in our hospital between December 2016 and December 2018,and 43 patients underwent open and other 43 underwentlaparoscopic portal-azygos vein devascularization and splenectomy.Results The bleeding volume and hospital stay in patients with laparoscopic surgery were(180.8±23.1)ml and(6.0±1.3)d,significantly less or shorter than[(286.4±35.7)ml and(8.6±1.5)d,P<0.05]in patients with open surgery;seven days after operation,the white blood cell andplatelet counts in patients with laparoscopic surgery were(8.9±1.4)×10^9/L and(132.0±28.9)×109/L,and those in patients with open operation were(7.2±1.8)×10^9/L and(125.6±30.3)×10^9/L,respectively,all significantly increased as compared to these before operation(P<0.05);the portal vain diameters and blood volume in patients with laparoscopic operationwere(1.2±0.1)cm and(911.7±261.7)ml/min,and those in patients with open surgery were(1.2±0.2)cm and(888.5±191.5)ml/min,respectively,all significantly narrowed or decreased as compared to these beforeoperation(P<0.05);the post-operational complications in patients with laparoscopic surgery was 9.3%,much lower than 37.2%(P<0.05)in patients with open operation.Conclusion The application of laparoscopic portal-azygos vein devascularization and splenectomy is efficacious in the treatment of patients with cirrhotic portal hypertension and megaspleen.It might have less trauma,low incidence of complications and quick recovery.