手助腹腔镜与开腹脾切除加门-奇静脉阻断术的前瞻性对比研究

目的 :探讨手助腹腔镜脾切除加门 -奇静脉阻断术的可行性及优越性。方法 :随机将肝硬化并门静脉高压 5 0例分为 2组 ,2 5例行手助腹腔镜脾切除加门 -奇静脉阻断术 ,2 5例行开腹手术 ,比较 2组的手术时间、术中出血量 ,术后住院时间 ,术后肛门排气时间 ,术后并发症 ,术前及术后 1～3d每日晨血清胃动素、C反应蛋白 (CRP)、肿瘤坏死因子 (TNF)及白细胞介素 6 (IL 6 )的动态变化。结果 :2 5例手助腹腔镜脾切除加门 -奇静脉阻断术获得成功 ,术中术后无并发症发生。与开腹组比较 ,除手术时间差异无显著性外 ,其余各项指标差异均有显著性 (P <0 0 5 ) ,手助腹腔镜组术中出血少 ,术后胃动素高峰值提前肛门排气时间早 ,术后并发症少 ,术后住院时间短 ,开腹组术后第 1天和 (或 )第 3天CRP、IL 6、TNF均较术前升高 (P <0 0 1) ;手助腹腔镜组创伤反应比开腹组低 (P <0 0 1)。结论 :手助腹腔镜脾切除加门 -奇静脉阻断术安全可行的 ,且比开腹手术有优越性。

The prospective and comparative study of hand assistant laparoscopic splenectomy plus porta-agygous devascularization and open surgery

Objective:To explore the feasibility and advantage of hand assistant laparoscopic splenectomy plus porta-agygous devascularization.Methods:50 cases with hepatocirrhosis,portal hypertension patients were divided into two groups with 25 cases in each group.25 cases were treated by hand assistant laparoscopic splenectomy plus porta-agygous devascularization,25 patients were treated by open surgery.The operative parameters including operating time,blood loss,postoperative days of in hospital,venting time,complication and GAS,CRP,TNF,IL-6 were recorded in preoperative period and the morning of 1-3 days postoperation.Results:25 cases were successful by hand assistant laparoscopic splenectomy plus porta-agygous devascularization without complication,compared with open surgery,there was no significantly different on the operation time and operative blood loss(P<0.05).It shows that hand assistant laparoscopic splenectomy plus porta-agygous devascularization could less blood loss,promote the peak of GAS of postoperation and venting time earlier,the days in hospital shorter.GAS,CRP,TNF,IL-6 were recorded in preoperative period and the morning of 1-3 days postoperation is higher than preoperation in open surgery.It was proved that the response reaction in hand assistant laparoscopic splenectomy plus porta-agygous devascularization was lower than that in open surgery.Conclusions:Hand assistant laparoscopic splenectomy plus porta-agygous devascularization is feasible and safety,more advantage than open surgery.