临床外科杂志 ›› 2020, Vol. 28 ›› Issue (8): 747-750.doi: 10.3969/j.issn.1005-6483.2020.08.016

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开腹与腹腔镜脾切除分别联合贲门周围血管离断术治疗肝硬化门静脉高压的临床疗效分析

  

  1. 223300 江苏省淮安市淮阴医院普外科
  • 出版日期:2020-08-20 发布日期:2020-08-20

Comparative analysis of the clinical effect of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhosis with portal hypertension

  1. Department of General Surgery,Huaiyin Hospital,Jiangsu Province,Huai'an 223300,China
  • Online:2020-08-20 Published:2020-08-20

摘要: 目的  分析开腹与腹腔镜脾切除分别联合贲门周围血管离断术治疗肝硬化门静脉高压临床效果。
方法  2016年5月~2019年3月本院收治的肝硬化门静脉高压病人100例,将其随机分为对照组、观察组,每组各50例。对照组采用开腹手术联合贲门周围血管离断术,观察组采用腹腔镜脾切除联合贲门周围血管离断术。对比两种手术对治疗肝硬化门静脉高压的围术期指标、血常规、肝功能情况、术后不良反应及胃底静脉曲张程度影响。
结果  观察组手术时间、术后住院时间、术后出血量、腹腔引流管放置时间与对照组比较,差异有统计学意义(P<0.05);观察组术后血小板和白细胞高于术前和对照组,差异有统计学意义(P<0.05);观察组术后门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)高于术前,且低于对照组,差异有统计学意义(P<0.05);观察组术后Child-Pugh评分低于术前及对照组,差异有统计学意义(P<0.05);观察组手术后2周内并发症低于对照组,术后胃底静脉曲张改善程度优于对照组,差异有统计学意义(P<0.05)。
结论  腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压能减少对肝功能的影响,缩短术后恢复期,降低术后并发症发生率。

关键词: 开腹脾切除, 腹腔镜脾切除, 贲门周围血管离断术, 肝硬化门静脉高压, 临床效果

Abstract: Objective To compare the clinical effect of laparoscopic splenectomy and open surgery combined with pericardial devascularization in the treatment of portal hypertension.
Methods From May 2016 to March 2019,100 cirrhotic patients with portal hypertension were randomly divided into control group and observation group(50 cases each).Patients in the observation group were treated with laparoscopic splenectomy and pericardial devascularization.The perioperative indexes,blood routine,liver function,adverse reactions and the degree of gastric varices were compared between the two groups.
Results The operative time,postoperative hospital stay,postoperative blood loss and abdominal drainage tube placement time of the observation group were statistically significant compared with the control group(P<0.05).Platelets and white blood cells in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).AST and ALT in the observation group were higher than those in the control group,the score of Child-Pugh which was lower than and the control group,the difference were both statistically significant(P<0.05).The postoperative complications in the observation group were lower than those in the control group within 2 weeks after operation,and the postoperative improvement degree of gastric varices was better than that in the control group,with statistically significant difference(P<0.05).
Conclusion Laparoscopic splenectomy combined with pericardial devascularization can effectively reduce the impact on liver function,shorten the postoperative recovery period and reduce the incidence of postoperative complications.

Key words: open splenectomy, laparoscopic splenectomy, pericardial devascularization, cirrhosis and portal hypertension, clinical effect

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