简易手助器行腹腔镜脾切除加贲门周围血管离断术治疗肝硬化门脉高压症的临床疗效

摘 要] 目的 比较开放、完全腹腔镜和简易手助器腹腔镜脾切除术加贲门周围血管离断术治疗肝硬化门脉高压症伴胃底食管静脉曲张的临床疗效。方法 回顾性分析2014 年1 月至2016 年12 月苏州大学附属第一医院施行的22 例开放脾切除加贲门周围血管离断术（开放组）、18 例完全腹腔镜脾切除加贲门周围血管离断术（完全腹腔镜组）和15例简易手助器腹腔镜脾切除加贲门周围血管离断术（简易手助器组）患者的临床资料，比较三组的手术时间、术中出血量、术后住院时间、引流管拔除时间、术后镇痛时间和术后并发症等资料。结果 开放组、完全腹腔镜组和简易手助器组平均手术时间分别为（147±36）min、（ 236±57）min和（157±30）min（F=24.601，P < 0.01），中位术中出血量分别为115 mL、212 mL和128 mL（H=8.622，P < 0.05）；组间比较显示，简易手助器组手术平均时间和中位术中出血量均少于完全腹腔镜组（均数差78.87 min，P < 0.01；Bonferroni校正，P < 0.05）。三组术后引流管拔除时间分别为（9.1±5.0）d、（ 6.4±5.2）d和（5.3±1.9）d（F=3.645，P < 0.05），术后镇痛时间分别为（4.2±0.9）d、（ 2.8±1.7）d和（2.8±1.1）d（F=8.739，P < 0.01），简易手助器组引流管拔除时间和术后镇痛时间均少于开放组（均数差分别为3.80 d和1.43 d，P < 0.05）。简易手助器组无中转开腹，完全腹腔镜组有5例中转开腹（Fisher确切概率法，P < 0.05）。三组均无围手术期死亡病例，其术后住院时间及脾脏长径、术后并发症发生率差异均无统计学意义（P >0.05）。结论 简易手助器行腹腔镜脾切除术加贲门周围血管离断术具有完全腹腔镜手术的微创性，且兼具术中出血少、手术时间短、中转开腹率低等优势，降低了手术风险和难度；且此手助器制作简易，利于该术式在基层医院中推广应用。

Laparoscopic splenectomy plus esophagogastric devascularization with simple hand-assisteddevice for the treatment of liver cirrhosis and portal hypertension

Abstract Objective To compare the clinical outcomes of open, laparoscopic, and simple hand-assisteddevice laparoscopic splenectomy and esophagogastric devascularization for treatment of portal hypertensionand esophageal varices due to liver cirrhosis. Methods From Jan. 2014 to Dec. 2016, open splenectomyand esophagogastric devascularization (OPED group), pure laparoscopic splenectomy and esophagogastricdevascularization (LSED group) and laparoscopic splenectomy and esophagogastric devascularization withsimple hand-assisted device (HALSED group) were respectively performed on 22, 18 and 15 patients withliver cirrhosis and portal hypertension in the First Affiliated Hospital of Soochow University. The operation duration, blood loss, postoperative hospitalization duration, drainage tube time, postoperative analgesia time andpostoperative complications were reviewed and compared among three groups. Results The mean operationduration was (147±36) min, (236±57) min and (157±30) min, (F=24.601, P<0.01) in the OPED, LSED andHALSED groups, respectively. And the median blood loss was 115 mL, 212 mL and 128 mL (H=8.622, P<0.05),respectively. The average time of operation and the volume of intraoperative blood loss in the HALAED groupwere less than LSED group (mean difference 78.87 min, P<0.01, Bonferroni-corrected, P<0.05). The extractiontime of postoperative drainage tube was (9.1±5.0) d, (6.4±5.2) d and (5.3±1.9) d, (F=3.645, P<0.05), and thepostoperative analgesia time was (4.2±0.9) d, (2.8±1.7) d and (2.8±1.1) d, (F=8.739, P<0.01) in the OPED, LSEDand HALSED groups, respectively. The extraction time of drainage tube and postoperative analgesia time in theHALSED group were less than the OPED group (mean difference was 3.80 d and 1.43 d, P<0.05). Five patientsin converted LSED group to open surgery, but there were no conversion to open surgery in the HALSED group(Fisher's exact test, P<0.05). All patients had no perioperative death, and there were no statistically significantdifference in postoperative hospitalization duration, splenic length and postoperative complication rate amongthree groups. Conclusion Laparoscopic splenectomy and esophagogastric devascularization with simple handassisteddevice has the same advantages of complete laparoscopic surgery, and it also can shorten the operationtime and reduce the intraoperative bleeding and the rate of conversions. And this hand-assisted device is easy tomake, which is beneficial to the application in the primary hospital.