肝胆胰外科杂志2025，Vol.37Issue(2)：86-92,7.DOI:10.11952/j.issn.1007-1954.2025.02.003
腹腔镜脾切除联合贲门周围血管离断术诱导失代偿肝硬化再代偿的临床研究
Clinical study on inducing recompensation of decompensated cirrhosis by laparoscopic splenectomy plus esophagogastric devascularization
摘要
Abstract
Objective To investigate the effects of laparoscopic splenectomy plus esophagogastric devascularization(LSED)on achieving recompensation in patients with decompensated cirrhosis,and to explore the correlation between postoperative recompensation and patient's prognosis.Methods The clinical data of 87 patients with decompensated cirrhosis who underwent LSED at the Second Affiliated Hospital of Air Force Medical University between Nov.2013 and Mar.2022 were retrospectively analyzed.Based on the Baveno Ⅶcriteria for cirrhosis recompensation and the follow-up results in the first year after LSED,all 87 patients were divided into the recompensation group(n=54)and the non-recompensation group(n=33).The Logistic regression analysis was used to explore the related factors for recompensation.The Kaplan-Meier method was used to construct survival curves.Additionally,the Cox regression model analysis was used to investigate the influencing factors for survival outcome(gastrointestinal bleeding or liver cancer occurring 1 year after LSED).Results Among all 87 patients,54(62.1%)achieved recompensation within the first year after LSED.The preoperative indocyanine green retention rate at 15 minute(ICG R15)<15%(adjusted OR=2.99,95%CI 1.11 to 8.02,P=0.030)and postoperative platelets≥211×109/L(adjusted OR=2.96,95%CI 1.13 to 7.74,P=0.027)were independent facilitating factors for recompensation.The cumulative survival rates without gastrointestinal bleeding or liver cancer at 2-,4-and 6-year after LSED in recompensation group and non-recompensation group were 98.1%vs 78.8%,92.6%vs 67.6%,77.1%vs 33.8%,respectively,and the differences were statistically significant(all P<0.05).Multivariate Cox regression analysis showed that,recompensation(adjusted HR=0.19,95%CI 0.07 to 0.54,P=0.002)was an independent protective factor for prognosis of patients with decompensated cirrhosis after LSED.Conclusion LSED can enable 60%of patients with decompensated cirrhosis to achieve recompensation within 1 year after surgery.Furthermore,the patients who achieved recompensation have significantly reduced risks of upper gastrointestinal bleeding or liver cancer after LSED.关键词
肝硬化/失代偿/脾切除术/贲门周围血管离断术/门静脉高压症/再代偿Key words
cirrhosis/decompensation/splenectomy/esophagogastric devascularization/portal hypertension/recompensation分类
临床医学引用本文复制引用
章铭,王栋,陈晓,梁德锋,曹彦龙,杨涛,黄博,鲁建国,阴继凯..腹腔镜脾切除联合贲门周围血管离断术诱导失代偿肝硬化再代偿的临床研究[J].肝胆胰外科杂志,2025,37(2):86-92,7.基金项目
空军军医大学第二附属医院科技创新发展基金重点项目(2019LCYJ005) （2019LCYJ005）
空军军医大学第二附属医院临床新技术新业务项目(2022XJSXYW005). （2022XJSXYW005）
