腹腔镜食管胃底曲张静脉断流术联合脾切除或脾保留对肝硬化性门静脉高压症患者近远期预后的影响

目的 比较在行腹腔镜食管胃底曲张静脉断流术时联合脾切除或采取脾保留对肝硬化性门静脉高压症患者近远期预后的影响。方法 3 0例肝硬化性门静脉高压症患者接受腹腔镜下断流术联合脾切除术,另30例采取断流术和脾保留术。结果 术后2 w,脾切除组门静脉内径和血流量分别为（1.1±0.2） cm和（820.1±101.1） ml/min,明显低于脾保留组【分别为（1.3±0.2） cm和（941.0±188.1） ml/min,P<0.05】,平均血流速度为（19.2±3.1）cm/s,明显快于脾保留组的（16.2±2.5） cm/s（P<0.05）;术后3 m,脾切除组血清层粘连蛋白水平为（100.9±29.1） ng/L,显著低于脾保留组的（126.7±30.1） ng/L（P<0.05）;随访发现脾切除组门静脉血栓、消化道出血和腹水发生率分别为3.3%、0.0%和10.0%,显著低于脾保留组的16.7%、26.7%和33.3%（P<0.05）,脾保留组死亡2例（6.7%）。结论 对于肝硬化性门静脉高压症患者在行腹腔镜下曲张静脉断流术时要谨慎采取脾保留手术,可能带来不利的临床后果。

Outcomes of laparoscopic esophagogastric devascularization and splenectomy or preserving spleens in patients with cirrhotic portal hypertension

Objective To analyze the outcomes of laparoscopic esophagogastric devascularization and splenectomy or preserving spleens in patients with cirrhotic portal hypertension. Methods 60 patients with cirrhotic portal hypertension were divided into the splenectomy group （n=30） and spleen preservation group （n=30） according to the operation carried out. Results At the end of two weeks after operation,the diameter of portal veins and blood flow volumes in the splenectomy group were（1.1±0.2） cm and（820.1±101.1） ml/min, significantly narrower or smaller than those in the spleen preservation group [（1.3±0.2） cm and （941.0±188.1） ml/min, P<0.05],while the average blood flow velocity [（19.2±3.1） cm/s] was significantly higher than that in the spleen preservation group [（16.2±2.5） cm/s,P< 0.05];serum levels of laminin in the splenectomy group 3 month after operation was （100.9±29.1） ng/L,significantly lower than that in the spleen preservation group [（126.7±30.1） ng/L,P<0.05];the incidence rates of portal venous thrombosis,gastrointestinal bleeding and ascites in the splenectomy group during follow-up were 3.3%,0.0%,10.0%,much lower than those in the spleen preservation group （16.7%,26.7%,33.3%,P<0.05）;during the follow-up period,2（6.7%） patients in the spleen preserving group died. Conclusion The spleen preservation must be carefully taken in laparoscopic devascularization in patients with liver cirrhosis and portal hypertension,which might lead to severe outcomes in this setting.