腹腔镜脾切除及贲门周围血管离断术治疗门静脉高压症的疗效评价

目的比较门静脉高压症病人行腹腔镜和开腹脾切除及贲门周围血管离断术的临床效果，评估腹腔镜手术的安全性及有效性。方法回顾性分析2010年1月至2014年5月开展的腹腔镜脾切除及贲门周围血管离断术（laparoscopic splenectomy splenectomy plus pericardial devascular—ization，18）103例病人和开腹脾切除及贲门周围血管离断术（open splenectomy plus perieardial devas—cularization，0S）110例病人的临床资料。结果两组病人手术均获得成功，无围手术期死亡，术后均康复出院，术后随访半年内无明显并发症。LS组中转开腹2例（中转率为1．9％）。LS组的平均手术时间长于OS组（334．2±41．2）rain与（241．7±49．1）min，P=0．027]；而LS组与OS组比较，术中出血量（793．3±113．2）ml与（914．5±89．1）ml，P=0．009]、术后腹腔总引流量（834．1±95．4）ml与（1008．1±126．2）ml，P=0．016]均明显减少，术后排气时间E（42．7±9．3）h与（56．3±7．1）h，P=0．01]、术后住院时间（7．5±0．9）d与（8．9±0．9）d，P=0．043]明显缩短，术后并发症发生率差异无统计学意义（P〉0．05）。结论门静脉高压症病人行腹腔镜脾切除及贲门周围血管离断术安全有效，比传统开腹手术具有微创的优势。

Efficacy and safety of laparoscopic splenectomy plus pericardial devascularization for patients with portal hypertention

Objective To evaluate the efficacy and safety of laparoscopic splenectomy plus pericardial devascularization （LS） versus open splenectomy plus pericardial devascularization （OS） for pa- tients with liver cirrhosis and portal hypertension. Methods Retrospective analyses were performed for the clinical data of 103 cases of LS and 110 cases of OS from January 2010 to May 2014. Results The operations of two groups were successfully performed without perioperative mortality. All patient recovered. After discharge, no complications occurred during a 6-month follow-up. In group LS, 2 cases converted into laparotomy （a conversion rate of 1.9 %）. The mean operative duration was longer in LS than that that in OS （334. 2 ±41.2）vs （241.7± 49. 1）min,P = 0. 027]. In group LS, blood loss （793. 3 ± 113. 2） vs （914. 5 ± 89. 1） ml, P = 0. 009], total abdominal drainage volume （834. 1 ±95. 4）vs （1008. 1 ＋ 126. 2）ml, P = 0. 016], mean time of bowel function recovery （42. 7 ± 9. 3） vs （56. 3±7. 1） hours, P = 0. 011） and postoperative hospitalization decreased significantly than OS （7. 5± 0. 9）vs. （8. 9 ± 0. 9）days, P = 0. 043]. No significant inter-group difference existed in liver function or＇mean weight of excised spleen （P〉0. 05）. The incidence of postoperative complications showed no statistical significance （P〉0. 05）. Conclusions For portal hypertension, the clinical efficacies of LS are better than those of OS.