腹腔镜门脉高压症脾切除的临床效果分析

目的探讨腹腔镜脾切除术(LS)治疗门脉高压症的临床效果。方法回顾性分析2015年3月至2016年6月接受治疗的85例门脉高压患者的临床资料,根据其治疗方式分为传统手术组(40例)和LS组(45例),传统手术组采用单纯贲门周围血管离断术,LS组采用腹腔镜脾切除术。应用SPSS 11.5软件进行统计学分析。两组患者手术一般情况、肝肾功能和生活质量采用均数±标准差表示,t检验;两组患者并发生症发生率的比较采用卡方检验。P0.05差异有统计学意义。结果 LS组手术时间较传统手术组短(t=21.393,P0.001),术中出血量较传统手术组少(t=49.471,P0.001);两组患者术前肝肾功能无差别,术后LS组ALT、AST和TBIL水平低于传统手术组(t=13.323、5.307、6.313,P0.001);两组患者手术前生活质量无差别,术后半年,LS组生活质量明显优于传统手术组;LS组出血、腹水和肝肾综合征发生率明显低于传统手术组(χ2=5.977,P=0.014)。结论腹腔镜下脾切除术对门脉高压症有较好的治疗效果,可明显改善患者的肝功能,降低并发症发生率,具有临床推广应用的价值。

Clinical analysis of laparoscopic splenectomy for portal hypertension

Objective To investigate the clinical outcome of laparoscopic splenectomy (LS) in the treatment of portal hypertension.Methods The clinical data of 85 patients with portal hypertension were retrospectively analyzed from March 2015 to June 2016, including 40 cases who received open pericardial devascularization in traditional operation group and 45 cases who underwent laparoscopic splenectomy in LS group.Statistical analysis were performed by using SPSS 11.5 software.Perioperative measurement data including liver and kidney function and quality of life were expressed as mean±standard deviation (±s), and were examined by using t test.Postoperative complications were analyzed by Chi-square test.A P value <0.05 was considered as statistically significant difference.Results The operation time of the LS group was shorter than that of the traditional operation group (t=21.393, P<0.001), and the intraoperative blood loss was less than that of the traditional operation group (t=49.471, P<0.001).There was no significant difference of preoperative liver and kidney function between two groups.After operation, the levels of ALT, AST and TBIL in the LS group were lower than those in the traditional operation group respectively (t=13.323, 5.307, 6.313, P<0.001).There was no significant difference of quality of life between the two groups before operation.The quality of life in the LS group was significantly better than that in the traditional operation group 6 months after operation.Complications such as bleeding, ascites and hepatorenal syndrome in LS group were significantly lower than those in traditional operation group (X2=5.977, P=0.014).Conclusion Laparoscopic splenectomy for portal hypertension has good curative effect, could significantly improve the liver function of patients, and could reduce the incidence of complications, with the clinical application value.