中华肝脏外科手术学电子杂志Issue(5)：288-292,5.DOI:10.3877/cma.j.issn.2095-3232.2015.05.008
腹腔镜下脾切除联合内镜下食管曲张静脉套扎术在肝硬化门静脉高压症中的应用价值
Application value of laparoscopic splenectomy combined with endoscopic variceal ligation in cirrhosis and portal hypertension
摘要
Abstract
ObjectiveTo investigate the application value of laparoscopic splenectomy combined with endoscopic variceal ligation in cirrhosis and portal hypertension.MethodsSixty-three patients with cirrhosis and portal hypertension undergoing laparoscopic splenectomy combined with endoscopic variceal ligation in Lingnan Hospital, the Third Afifliated Hospital of Sun Yat-sen University between September 2011 and September 2014 were included in the prospective study. The patients were randomized into the laparoscopy group and the laparotomy group according to different surgical procedures. Among the 28 patients in the laparoscopy group, 25 were males and 3 were females with the age ranging from 40 to 69 years old and the median of 55 years old. Among the 35 patients in the laparotomy group, 32 were males and 3 were females with the age ranging from 43 to 69 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients of two groups underwent endoscopic variceal ligation during the splenectomy. The duration of operation, intraoperative blood loss, length of hospital stay, treatment costs and incidence of postoperative complications of two groups were observed. The comparison of the observed indexes of two groups was conducted usingt test and the rate comparison was conducted using Fisher's exact test.ResultsAll the patients completed the surgery successfully. The duration of operation and the intraoperative blood loss were (113±8) min and (204±52) ml for the laparoscopy group, and were (106±6) min and (226±63) ml for the laparotomy group where no significant difference was observed (t=1.97,-0.75;P>0.05). The length of hospital stay and treatment costs of laparoscopy group were (6.0±1.2) and (35 000±3 000) RMB, which were signiifcantly lower than (11.2±2.7) and (45 000±1 000) RMB of laparotomy group (t=-4.87,-6.81;P<0.05). Eight patients in the laparoscopy group developed complications, among them, 7 were with portal venous thrombosis and 1 was with recurrent hemorrhage. Seventeen patients in the laparotomy group developed complications, among them, 10 were with portal venous thrombosis and 7 were with fat liquefaction of incisions. The incidence of fat liquefaction of incisions in laparoscopy group was signiifcantly lower than that of the laparotomy group (P=0.035).ConclusionLaparoscopic splenectomy combined with endoscopic variceal ligation can achieve the similar curative effect with laparotomy and has the advantages of small operational wound, quick recovery, less complications, as well as shorter length of hospital stay and lower total treatment costs.关键词
腹腔镜/脾切除术/自然腔道内镜手术/肝硬化/高血压,门静脉Key words
Laparoscopes/Splenectomy/Natural orifice endoscopic surgery/Liver cirrhosis/Hypertension, portal引用本文复制引用
胡昆鹏,刘波,姚志成,王庆亮,熊志勇,黄河,许世磊,张鹏,陈新桂,杨培生..腹腔镜下脾切除联合内镜下食管曲张静脉套扎术在肝硬化门静脉高压症中的应用价值[J].中华肝脏外科手术学电子杂志,2015,(5):288-292,5.基金项目
教育部博士点基金新教师类 （）
