肝硬化门静脉高压症行脾切除贲门周围血管离断术后再出血的二级预防价值

目的:分析脾切除联合贲门周围血管离断术对肝硬化门静脉症术后再出血的预防价值.方法:收集80例肝硬化门静脉高压症患者的临床资料,按手术方式分为腹腔镜脾切除联合贲门周围血管离断术+吻合器组(A组,n=45)与传统开腹手术(B组,n=35),比较手术前后患者肝功能的变化,统计术后再出血及并发症发生情况.结果:①A组手术时间长于B组,但其术中出血量少于B组,术后排气时间、进食时间、拔管时间及住院时间均短于B组.②两组术后肝功能均明显改善,A组术后并发症发生率及术后再出血发生率均低于B组.结论:在肝硬化门静脉高压症患者的治疗中,采用腹腔镜脾切除联合贲门周围血管离断术,配合吻合器应用,微创,患者术中出血少,术后恢复快,术后并发症发生率低,再出血率低,安全性高.

Value of secondary prevention of rebleeding in cirrhotic patients with portal hypertension after splenectomy pericardia vascular disconnection

Objective To analyze the value of splenectomy pericardia vascular disconnection in the prevention of postop-erative rebleeding in cirrhotic patients with portal hypertension. Methods The clinical data of 80 cirrhotic patients with portal hypertension were collected and were divided into laparoscopic splenectomy combined with pericardia vascular disconnection and anastomat group (group A, n=45) and traditional open surgery (group B, n=35). Changes of liver function before and after surgery were compared, and the incidence of rebleeding and complications was statistically analyzed. Results The duration of surgery in group A was longer than that in group B, the blood loss during surgery was less than that of group B, and the exhaust time, eating time, duration of extubation and length of hospital stay were shorter than those in group B. The liver function of both groups were significantly improved after surgery, and the incidence rates of postoperative complications and rebleeding in group A were lower than those in group B. Conclusion In the treatment of cirrhotic patients with portal hypertension, the application of laparoscopic splenectomy combined with pericardia vascular disconnection and anastomat is minimally invasive, with less blood loss, faster postoperative recovery, lower incidence of postoperative complications, lower rate of rebleeding and high safety.