腹腔镜下巨脾切除加贲门周围血管离断术治疗肝硬化门静脉高压的疗效分析

目的探讨腹腔镜下巨脾切除术联合贲门周围血管离断术治疗肝硬化门静脉高压的疗效和安全性。方法回顾性分析2012年6月至2014年6月收治的行开腹巨脾切除术联合贲门周围血管离断术治疗的肝硬化门静脉高压患者26例,作为开腹组;另选取2014年7月2016年6月收治的行腹腔镜下巨脾切除术联合贲门周围血管离断术的肝硬化门静脉高压患者26例,作为腹腔镜组。采用SPSS 19.0统计学软件进行数据分析,两组临床指标和手术前后WBC、PLT水平均使用(x珋±s)表示,采用t检验,两组术后并发症发生率采用χ2检验,P0.05差异有统计学意义。结果腹腔镜组术中出血量、术后首次进食时间、下床活动时间、肛门排气时间、脾窝引流管拔除时间和住院时间少于开腹组,差异有统计学意义(P0.05);两组术后2周WBC、PLT水平均高于术前,差异有统计学意义(P0.05),组间无明显差异(P0.05);腹腔镜组术后总并发症4例(15.4%),明显低于开腹组15例(57.7%),差异具有统计学意义(χ2=10.035,P0.05)。结论腹腔镜下巨脾切除术联合贲门周围血管离断术治疗肝硬化门静脉高压疗效确切,值得推广。

Clinical analysis of laparoscopic giant splenectomy plus pericardial devascularization in the treatment of cirrhotic portal hypertension

Objective To evaluate the efficacy and safety of laparoscopic giant splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension . Methods A retrospective analysis were performed from June 2012 to June 2014, 26 patients with liver cirrhosis and portal hypertension underwent open splenectomy combined with cardiac peripheral devascularization were divided into open group.the other 26 patients with liver cirrhosis and portal hypertension from July 2014 June 2016 underwent laparoscopic giant splenectomy plus pericardial devascularization were divided into laparoscopic group.Clinical data were analyzed by using statistical software SPSS 19.0.Measurement data such as perioperative indicators ( WBC, PLT) were expressed as mean ±standard deviation ( -x ±s), and were examined by using t test.Count data, such as postoperative complication were examined by using χ2 test.A P value <0.05 was considered as statistically significant difference . Results There were no significant difference between two groups in terms of blood loss , feeding time, ambulation time, exhaust time, drainage time and hospital stay (P <0.05).The WBC and PLT levels in both two groups were higher than those before the operation at the end of the week , with significant difference (P <0.05), however there was no significant difference between two groups ( P >0.05) .There were 4 cases (15.4%) of postoperative complications in laparoscopic group, which was significantly lower than 15 patients (57.7%) in open group, with significant difference ( χ2 =10.035, P <0.05). Conclusion Laparoscopic giant splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension is effective and worthy of clinical promotion.