中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
5期
353-356
,共4页
肝硬化%高血压,门静脉%腹腔镜%脾切除术%断流术
肝硬化%高血壓,門靜脈%腹腔鏡%脾切除術%斷流術
간경화%고혈압,문정맥%복강경%비절제술%단류술
Liver cirrhosis%Hypertension,portal%Laparoscopes%Splenectomy%Devascularization
目的 探讨完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的可行性、有效性和安全性.方法 对26例患者行巨脾切除联合贲门周围血管离断术,其中16例行完全腹腔镜下二级脾蒂离断法脾切除联合贲门周围血管离断术,10例行传统开腹手术.比较两组的手术时间、术中出血量、术后并发症发生率、术后外周血血小板数值及术后住院时间等.结果 腹腔镜组成功完成手术12例,中转开腹4例.腹腔镜组与开腹组平均手术时间分别为(315±77) min和(291±31)min,两组相比差异无统计学意义,t=0.892,P=0.384；术中平均出血量分别为(409±216) ml和(980±402) ml,两组相比差异有统计学意义,t=4.105,P＜0.01；术后并发症发生率分别为17％和30％,两组相比差异无统计学意义,x2=0.064,P=0.525；术后平均住院时间分别为(10±3)d和(17±8)d,两组相比差异有统计学意义,t=2.539,P＜0.01.结论 完全腹腔镜下巨脾切除联合贲门周围血管离断术安全、可行、有效,具有出血少、痛苦小、术后住院时间短的优点,是一种值得推广的微创手术.
目的 探討完全腹腔鏡下巨脾切除聯閤賁門週圍血管離斷術治療肝硬化門靜脈高壓癥的可行性、有效性和安全性.方法 對26例患者行巨脾切除聯閤賁門週圍血管離斷術,其中16例行完全腹腔鏡下二級脾蒂離斷法脾切除聯閤賁門週圍血管離斷術,10例行傳統開腹手術.比較兩組的手術時間、術中齣血量、術後併髮癥髮生率、術後外週血血小闆數值及術後住院時間等.結果 腹腔鏡組成功完成手術12例,中轉開腹4例.腹腔鏡組與開腹組平均手術時間分彆為(315±77) min和(291±31)min,兩組相比差異無統計學意義,t=0.892,P=0.384；術中平均齣血量分彆為(409±216) ml和(980±402) ml,兩組相比差異有統計學意義,t=4.105,P＜0.01；術後併髮癥髮生率分彆為17％和30％,兩組相比差異無統計學意義,x2=0.064,P=0.525；術後平均住院時間分彆為(10±3)d和(17±8)d,兩組相比差異有統計學意義,t=2.539,P＜0.01.結論 完全腹腔鏡下巨脾切除聯閤賁門週圍血管離斷術安全、可行、有效,具有齣血少、痛苦小、術後住院時間短的優點,是一種值得推廣的微創手術.
목적 탐토완전복강경하거비절제연합분문주위혈관리단술치료간경화문정맥고압증적가행성、유효성화안전성.방법 대26례환자행거비절제연합분문주위혈관리단술,기중16례행완전복강경하이급비체리단법비절제연합분문주위혈관리단술,10례행전통개복수술.비교량조적수술시간、술중출혈량、술후병발증발생솔、술후외주혈혈소판수치급술후주원시간등.결과 복강경조성공완성수술12례,중전개복4례.복강경조여개복조평균수술시간분별위(315±77) min화(291±31)min,량조상비차이무통계학의의,t=0.892,P=0.384；술중평균출혈량분별위(409±216) ml화(980±402) ml,량조상비차이유통계학의의,t=4.105,P＜0.01；술후병발증발생솔분별위17％화30％,량조상비차이무통계학의의,x2=0.064,P=0.525；술후평균주원시간분별위(10±3)d화(17±8)d,량조상비차이유통계학의의,t=2.539,P＜0.01.결론 완전복강경하거비절제연합분문주위혈관리단술안전、가행、유효,구유출혈소、통고소、술후주원시간단적우점,시일충치득추엄적미창수술.
Objective To evaluate the feasibility,effectiveness and safety of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension in cirrhotic patients. Methods In this study 16 cases underwent initial totally laparoscopic splenectomy and paraesophagogastric devascularization,with 10 cases undergoing upfront open surgery as controls by one treatment group.Clinical data including operative time,intraoperative blood loss,post-operative complications and hospitalization were compared between the two groups. Results In the laparoscopic group the procedure was successfully performed in 12 cases.4 cases were converted to open surgery.The operative time in laparoscopic group and the open group was respectively (315 ± 77 ) min and (291± 31) min (P =0.384).The mean intro-operative blood loss was (409 ±216) ml and (980 ±402) ml (P ＜0.01).The post-operative stay was ( 10 ± 3 ) d and ( 17 ± 8 ) d ( P ＜ 0.01).Differences in post-operative complication rate between the two groups was not statistically significant ( 17％ vs.30％,P =0.525 ).Conclusions Laparoscopic splenectomy and pericardial devascularization is feasible,effective and safe for cirrhotic patients with portal hypertension,it has the advantage of less intra-operative blood loss,less pain and shorter hospitalization than open surgery.
