腹腔镜下门奇静脉断流术加脾切除治疗门脉高压症的临床研究

目的 观察腹腔镜下门奇静脉断流术加脾切除治疗门脉高压症(PHT)的临床效果.方法 选择2015年2月至2017年5月罗定市人民医院普外科收治的146例肝硬化门静脉高压症患者,并随机对照试验(Randomized Controlled Trial,RCT)分为两组,对照组73例给予开腹术门奇静脉断流术加脾切除治疗,观察组73例给予腹腔镜下门奇静脉断流术加脾切除治疗,比较两组临床效果.结果 观察组手术时间长于对照组(t=5.102 3,P＜0.05),而术中出血量、术后下床时间、平均排气时间及住院时间均显著低于对照组(t=-31.508 6、-36.903 7、-12.099 9、-11.489 0,均P＜0.05);两组住院费用差异无统计学意义(t=-0.592 5,P＞0.05);观察组术后并发症发生率5.48％,显著低于对照组的30.14％(x2=15.161 5,P＜0.05);观察组认知功能、心理功能、躯体功能、社会功能及总体功能均显著高于对照组(t=6.524 3、6.389 9、6.802 8、6.698 0、47.008 7,均P＜0.05).结论 腹腔镜下门奇静脉断流术加脾切除治疗门脉高压症(PHT)创伤小、恢复快、疗效显著、术后并发症低,是可行的、安全的、有效的,能够有效提高患者生活质量.

Clinical study of laparoscopic portal azygous disconnection and splenectomy for portal hypertension

Objective To evaluate the clinical effect of laparoscopic portal azygous disconnection and splenectomy for portal hypertension (PHT).Methods A total of 146 patients with portal hypertension were randomly divided into a control group and an observation group according to randomized controlled trial (RCT),73 for each group.The observation group were treated with laparoscopic portal azygous disconnection and splenectomy and the control group with portal azygous disconnection and splenectomy.The clinical effects of the two groups were compared.Results The operation time was longer,the intra-operative bleeding volume was lower,and the postoperative off-bed time,average exhaustion time,and hospitalization time were shorter in the observation group than in the control group (t=5.102 3,-31.508 6,-36.903 7,-12.099 9,-11.489 0,all P ＜ 0.05).There was no statistical difference in the hospitalization cost between the two groups (t=-0.592 5,P ＜ 0.05).The incidence of postoperative complications was 5.48％ in the observation group and was 30.14％ in the control group(x2=15.1615,P ＜ 0.05).The cognitive function,psychological function,somatic function,social function,and overall function were significantly better in the observation group than in the control group (t=6.5243,6.3899,6.8028,6.6980,47.0087,all P＜0.05).Conclusion Laparoscopic portal azygous disconnection and splenectomy for PHT have the advantages of less trauma,quick recovery,remarkable curative effect,and low incidence of postoperative complications,is feasible,safe,and effective,and can improve the patients' quality of life.