手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的应用价值分析

目的：探讨手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者的临床应用价值，并为其临床应用提供依据。方法：共纳入52例确诊为门脉高压的患者，均行脾切除加门奇断流术，采用随机数字法平均分为观察组与对照组，观察组患者行手辅助腹腔镜手术，对照组患者行开腹手术。观察两组患者手术出血量、手术时间、住院时间等，并分析其对机体应激反应（TNF-α，IL-6，CRP）的影响。结果：观察组术中出血量、手术时间及术后引流量、引流时间、肛门排气时间、住院时间明显少于对照组，差异有统计学意义（P〈0．05）；对照组切脾最大直径大于观察组，但差异无统计学意义（P〉0．05）。术后观察组患者CRP、IL-6、TNF-α水平均明显低于对照组，差异有统计学意义（P〈0．05）。结论：手辅助腹腔镜脾切除加门奇断流术治疗门脉高压患者具有较好的临床疗效，可减少术中出血量、术后引流量，缩短手术时间、住院时间，机体应激反应较小。

A value analysis of the application of hand-assisted laparoscopic splenectomy combined with portal-azygous devascularization for portal hypertension

Objective：To investigate the clinical efficacy of hand-assisted laparoscopic splenectomy combined with portal-azygous devascularization for portal hypertension,in order to provide the basis for its clinical application. Methods：Fifty-two patients who suffered from portal hypertension were included in this study. All patients were performed splenectomy combined with portal-azygous devascularization. Patients were randomly divided into observation group and control group by random number method. 26 cases in observation group were given hand-assisted laparoscopy,26 cases in control group were given open procedure. The intraoperative bleeding, operative time and hospital stay were observed. The influences on stress responses （plasma levels of TNF-α, IL-6 and CRP） were measured after surgery and comparatively analyzed. Results ：The observation group showed significantly less intraoperative blood loss, shorter operation time, earlier anus exhaust, shorter hospital stay, fewer volume and shorter time of postoperative drainage, the differences were statistically significant （ P 〈 0.05 ）. The maximum diameter of spleen in control group was greater than that in observation group, but the difference was not statistically significant （ P 〉 0.05 ）. The value of laboratory test of observation group was significantly less than that of control group in such indexes as plasma levels of TNF-α, IL-6 and CRP after operation, the difference was statistically significant （ P 〈 0.05 ）. Conclusions： Hand-assisted laparoscopic splenectomy combined with portal-azygous devascularization for portal hypertension has a better clinical effect. It can reduce the intraoperative blood loss, postoperative drainage, operative time and hospital stay. The body＇s stress response is also lower.