手助腹腔镜与开腹脾切除断流术的临床对比研究

目的：比较手助腹腔镜和开腹手术治疗门脉高压症脾切除断流术的近期临床效果。方法：回顾分析2003年2月至2006年6月手助腹腔镜和同期开腹手术脾切除断流术各27例的临床资料。结果：腹腔镜组的平均手术时间明显长于开腹组（183min vs.163min,P〈0.05）,而术中出血量（630ml vs.1215ml）、术中输血量（601ml vs.1049ml）、腹腔总引流量（946mlvs.1545ml）、排气时间（79h vs.95h）、术后住院时间（13d vs.16d）均明显减少（P〈0.05）。术后肝功能、并发症发生率、切除脾重、住院总费用均无统计学差异（P〉0.05）。结论：手助腹腔镜脾切除断流术的近期效果明显优于传统开腹手术,且安全、可行,具有微创的优越性。

Comparative study on hand-assisted laparoscopic splenectomy and laparosplenectomy plus disconnection procedure on patients with portal hypertension

Objective:To compare the clinical effect of hand-assisted laparoscopic splenectomy plus disconnection procedure and laparosplenectomy on patients with portal hypertension.Methods:The clinical data of 27 cases of hand-assisted laparoscopic splenectomy plus disconrection and 27 cases of open procedure from Feb.2003 to Jun.2006 was retrospectively analyzed.Results:The mean operation time was longer in the laparoscopic group than that in the open group(184min vs.163min,P<0.05).The laparoscopic group decreased significantly in blood loss(630ml vs.1215ml),blood transfusion volume(601ml vs.1049ml),total abdominal drainage volume(946ml vs.1545ml),mean time of bowel function recovery(79h vs.95h)and postoperative hospitalization(13d vs.16d)than the open group.There was no significance between the two groups in the liver function,incidence of complications,mean weight of excised spleen and expenses of hospitalization(P>0.05).Conclusions:Clinical effects of patients treated by hand-assisted laparoscopic splenectomy plus disconnection procedure are better than those treated by laparosplenectomy.It is safe and feasible in clinical practice.