[1]刘成远* 李俊 江穆速 王坤 韩祥松 崔广宾.腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症[J].中国微创外科杂志,2020,01(1):19-45.
　Liu Chengyuan,Li Junjiang,Mu Su,et al.Laparoscopic Splenectomy for Massive Splenomegaly and Devascularization for Cirrhosis and Portal Hypertension[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):19-45.
点击复制

腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
19-45
栏目:
临床研究
出版日期:
2020-03-25

文章信息/Info

Title:
Laparoscopic Splenectomy for Massive Splenomegaly and Devascularization for Cirrhosis and Portal Hypertension
作者:
刘成远* 李俊 江穆速 王坤 韩祥松 崔广宾
（河南省商丘市第一人民医院胃肠肝胆三科，商丘476100）
Author(s):
Liu Chengyuan;  Li Junjiang;  Mu Su;  et al.
Department of Gastrointestinal Hepatobiliary, First People’s Hospital of Shangqiu, Shangqiu 476100, China
关键词:
腹腔镜; 脾切除术; 断流术; 肝硬化; 门静脉高压
Keywords:
Laparoscopy; Splenectomy; Devascularization; Cirrhosis; Portal hypertension
文献标志码:
A
摘要:
目的探讨腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症的可行性及效果。方法 回顾性分析我院2015年8月~2018年8月巨脾切除联合贲门周围血管离断61例资料，其中腹腔镜29例，开腹32例，比较2组手术及并发症情况。结果2组手术时间、术后1周白细胞及血小板计数差异无显著性（P>0.05）。腹腔镜组术中出血量、排气时间、拔除引流管时间、术后住院时间均优于开腹组［中位数300(100，500)ml vs. 330(150，550)ml，Z=-2.025，P=0.043；2（1，4）d vs. 4（2，5）d，Z=-5.279，P=0.000；4（3，5）d vs. 5（4，7）d，Z=-3.094，P=0.002；8（6，10）d vs. 10（8，13）d，Z=-4.967，P=0000］。腹腔镜组术后发热、切口感染、肺部感染、腹腔出血、胰漏发生率均低于开腹组，但差异无显著性（P>0.05）。腹腔镜组术后1周、2周、3个月门静脉系统血栓形成发生率均低于开腹组［13.8%(4/29) vs. 40.6%(13/32), χ2=5.449,P=0.020；17.2%(5/29) vs. 46.9%(15/32), χ2=6.062,P=0.014；17.2%(5/29) vs. 50.0%(16/32), χ2=7.232,P=0007］。结论在条件充分情况下，肝硬化门脉高压采用腹腔镜巨脾切除加断流术治疗是可行的，且较开腹手术具有一定优势。
Abstract:
ObjectiveTo explore the feasibility and effect of laparoscopic splenectomy for massive splenomegaly combined with devascularization in patients with hepatic cirrhosis of portal hypertension.MethodsClinical data of 61 patients admitted in our department treated with splenectomy for massive splenomegaly combined with pericardial devascularization were analyzed retrospectively, of which 29 cases were given laparoscopic surgery and 32 cases open surgery. The operation and complications of the two groups were compared.ResultsThere were no significant differences in operation time, postoperative WBC and PLT between the two groups (P>0.05). In the laparoscopic group, the intraoperative blood loss, postoperative exhaust time, removal of drainage time, postoperative hospitalization time were less or shorter than those in the open group with statistically significant difference ［M 300 (P25 100, P75 500) ml vs. 330 (150, 550) ml, Z=-2.025, P=0.043; 2 (1, 4) d vs. 4 (2, 5) d, Z=-5.279, P=0.000; 4(3,5) d vs. 5(4,7) d, Z=-3.094, P=0.002; 8 (6, 10) d vs. 10 (8,13) d, Z=-4.967, P=0.000］. The incidences of postoperative fever, postoperative infection, pulmonary infection, hemorrhage, and pancreatic leakage in the laparoscopic group were lower than those in the open group, but the differences were not statistically significant (P>0.05). The incidences of portal vein thrombosis at 1 week, 2 weeks, and 3 months after operation were lower than those in the open group, and the differences were statistically significant ［13.8% (4/29) vs. 40.6% (13/32), χ2=5.449, P=0020; 17.2% (5/29) vs. 46.9% (15/32), χ2=6.062, P=0.014; 17.2% (5/29) vs. 50.0% (16/32), χ2=7.232, P=0007］. ConclusionUnder sufficient conditions, using laparoscopic splenectomy combined with devascularization to treat hepatic cirrhosis of portal hypertension is feasible and has more advantages than the laparotomy.

参考文献/References:

[1]Habermalz B，Sauerland S，Decker G，et al.Laparoscopic splenectomy：the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES).Surg Endosc，2008,22(4):821-848.
[2]《腹腔镜肝胆胰手术操作指南》制定委员会.腹腔镜肝胆胰手术操作指南.临床肝胆病杂志,2019,35(7):1450-1458.
[3]Bassi C，Marchegiani G，Dervenis C,et al.The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula:11 years after.Surgery,2017,161(3):584-591.
[4]柏斗胜,蒋国庆,钱建军，等.腹腔镜断流术中保脾治疗肝硬化性门静脉高压症的疗效.中华普通外科杂志,2016,31(10):808-811.
[5]张豫峰,孔德才,陈壬寅,等.腹腔镜巨脾切除加断流术治疗肝硬化门静脉高压症.中华肝胆外科杂志,2012,18(7):519-521.
[6]Liu Y，Zhao L，Tang Y，et al.Laparoscopic versus open splenectomy and devascularization for massive splenomegaly due to portal hypertension.J Huazhong Univ Sci Technolog Med Sci，2016，36(6):876-880.
[7]Zhang Y，Wen TF，Yan LN，et al.Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastfic devascularization.World J Gastroenterol,2012，18(15):1834-1839.
[8]李巍,董晓彤,崔志新,等.腹腔镜脾切除术前CTA检查结果分析.山东医药,2011,51(2):68-69.
[9]邓小凡,张宇,刘兴超,等.血液回收机在腹腔镜脾切除术中的应用.中国内镜杂志,2013,19(6):611-613.
[10]孙加玉,李军,赵磊,等.腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症7例报告.中国微创外科杂志,2017,17(5):475-477.
[11]Zhang JS，Li L，Hou WY，et al. Spleenpreserving proximal splenicleft intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children.J Pediatr Surg,2015,50(6):1072-1075.
[12]黎东伟,李君久,熊秋华,等.脾蒂优先处理法在腹腔镜巨脾切除术中的临床应用.中国微创外科杂志,2018,18(3):230-232,240.

备注/Memo

备注/Memo:
*通讯作者，Email：liuchengyuan5@163.com
更新日期/Last Update: 2020-04-16