CAJ | 학술논문

目的探讨改良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症的安全性及其近期疗效.方法回顾性分析2010年1月至2013年2月扬州大学临床医学院收治的107例肝硬化门静脉高压症患者的临床资料.接受改良腹腔镜脾切除联合贲门周围血管离断术患者为改良腹腔镜组(37例),开腹脾切除联合贲门周围血管离断术为开腹组(70例),比较两组患者术中和术后情况.计量资料采用t检验或Mann-Whitney U 检验,计数资料采用x2检验.结果改良腹腔镜组患者的中位手术时间为210 min(185 ～245 min),明显长于开腹组的175 min(150 ～ 190 min),两组比较,差异有统计学意义(Z =-4.624,P＜0.05).改良腹腔镜组患者中位术中出血量为150 ml(100 ～200 ml)、术后第1天疼痛指数为2.5±0.9、术后进食欲望时间为(1.5±0.7)d、术后肛门排气时间为(2.4±1.0)d、术后下床活动时间为(2.7±0.7)d、术后住院时间为(10.5±2.2)d,均显著低于开腹组的300 ml(188 ～400 ml)、5.1±1.1、(2.8±0.6)d、(3.2±1.0)d、(5.9±0.9)d、(15.7±4.3)d,两组比较,差异有统计学意义(Z=-3.570,t=-12.546,-9.834,-3.635,-18.780,-8.350,P＜0.05).改良腹腔镜组5例患者术后发生并发症,显著少于开腹组的25例(x2=5.913,P＜0.05).结论改良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症安全可行且疗效确切,其近期疗效明显优于开腹手术.
목적 탐토개량복강경비절제연합분문주위혈관리단술치료간경화문정맥고압증적안전성급기근기료효.방법 회고성분석2010년1월지2013년2월양주대학림상의학원수치적107례간경화문정맥고압증환자적림상자료.접수개량복강경비절제연합분문주위혈관리단술환자위개량복강경조(37례),개복비절제연합분문주위혈관리단술위개복조(70례),비교량조환자술중화술후정황.계량자료채용t검험혹Mann-Whitney U 검험,계수자료채용x2검험.결과 개량복강경조환자적중위수술시간위210 min(185 ～245 min),명현장우개복조적175 min(150 ～ 190 min),량조비교,차이유통계학의의(Z =-4.624,P＜0.05).개량복강경조환자중위술중출혈량위150 ml(100 ～200 ml)、술후제1천동통지수위2.5±0.9、술후진식욕망시간위(1.5±0.7)d、술후항문배기시간위(2.4±1.0)d、술후하상활동시간위(2.7±0.7)d、술후주원시간위(10.5±2.2)d,균현저저우개복조적300 ml(188 ～400 ml)、5.1±1.1、(2.8±0.6)d、(3.2±1.0)d、(5.9±0.9)d、(15.7±4.3)d,량조비교,차이유통계학의의(Z=-3.570,t=-12.546,-9.834,-3.635,-18.780,-8.350,P＜0.05).개량복강경조5례환자술후발생병발증,현저소우개복조적25례(x2=5.913,P＜0.05).결론 개량복강경비절제연합분문주위혈관리단술치료간경화문정맥고압증안전가행차료효학절,기근기료효명현우우개복수술.
Objective To investigate the safety and short-term efficacy of modified laparoscopic and open splenectomy and pericardial devascularization for the treatment of cirrhotic portal hypertension.Methods The clinical data of 107 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University from January 2010 to February 2013 were retrospectively analyzed.Patients were divided into the modified laparoscopic group (37 patients) and the open group (70 patients).The intra-and postoperative condition of the patients of the 2 groups were compared.The measurement data were analyzed using the t test or Mann-Whitney U test,and the enumeration data were analyzed using the chi-square test.Results The median operation time of the modified laparoscopic group was 210 minutes (range,185-245 minutes),which was longer than 175 minutes of the open group (range,150-190 minutes),with significant difference between the 2 groups (Z =-4.624,P ＜ 0.05).The median volume of intra-operative blood loss,pain rating index of the first day after operation,first appetite time after operation,initial passage of flatus time,postoperative off-bed activity time and duration of postoperative hospital stay were 150 ml (range,100-200 ml),2.5 ± 0.9,(1.5 ± 0.7) days,(2.4 ± 1.0) days,(2.7 ± 0.7) days,(10.5 ± 2.2) days in the modified laparoscopic group,and 300 ml (range,188-400 ml),5.1 ± 1.1,(2.8 ± 0.6) days,(3.2 ± 1.0) days,(5.9 ± 0.9) days and (15.7 ± 4.3) days in the open group,with significant difference between the 2 groups (Z =-3.570,t =-12.546,-9.834,-3.635,-18.780,-8.350,P ＜ 0.05).The number of patients who had postoperative complications in the modified laparoscopic group was 5,which was significantly smaller than 25 in the open group (x2 =5.913,P ＜ 0.05).Conclusions The procedure of modified laparoscopic splenectomy and pericardial devascularization for cirrhotic portal hypertension is safe,feasible and with good therapeutic effect.It has better short-term clinical effect than open surgery.