CAJ | 학술논문

目的比较改良手助腹腔镜下和全腹腔镜下脾切除加贲门周围血管离断术治疗肝硬化门静脉高压症的临床效果.方法回顾性分析2007年1月至2011年12月进行的47例改良手助腹腔镜下脾切除加贲门周围血管离断术(改良手助腹腔镜组)和38例完全腹腔镜下脾切除加贲门周围血管离断术(完全腹腔镜组)的患者临床资料.改良手助腹腔镜组先在手助腹腔镜下完成脾切除术,再改为完全腹腔镜下行贲门周围血管离断术.比较两组患者的手术时间、术中出血量、术后并发症和术后住院时间等资料.结果改良手助腹腔镜组47例患者手术顺利,无中转开腹手术；完全腹腔镜组有2例患者因为术中出血中转开腹手术.改良手助腹腔镜组的平均手术时间为(154±32) min,术中出血量为(115±73) ml,均显著低于完全腹腔镜组[分别为(212±45) min和(172±57) ml].两组均无围手术期死亡.两组患者在术后胃肠功能恢复、平均术后住院时间和围手术期并发症发生率上差异无统计学意义.结论改良手助腹腔镜下脾切除联合贲门周围血管离断术安全性好,操作方便,术中出血少,兼具手助腹腔镜和完全腹腔镜手术的优势,值得临床推广.
목적 비교개량수조복강경하화전복강경하비절제가분문주위혈관리단술치료간경화문정맥고압증적림상효과.방법 회고성분석2007년1월지2011년12월진행적47례개량수조복강경하비절제가분문주위혈관리단술(개량수조복강경조)화38례완전복강경하비절제가분문주위혈관리단술(완전복강경조)적환자림상자료.개량수조복강경조선재수조복강경하완성비절제술,재개위완전복강경하행분문주위혈관리단술.비교량조환자적수술시간、술중출혈량、술후병발증화술후주원시간등자료.결과 개량수조복강경조47례환자수술순리,무중전개복수술；완전복강경조유2례환자인위술중출혈중전개복수술.개량수조복강경조적평균수술시간위(154±32) min,술중출혈량위(115±73) ml,균현저저우완전복강경조[분별위(212±45) min화(172±57) ml].량조균무위수술기사망.량조환자재술후위장공능회복、평균술후주원시간화위수술기병발증발생솔상차이무통계학의의.결론 개량수조복강경하비절제연합분문주위혈관리단술안전성호,조작방편,술중출혈소,겸구수조복강경화완전복강경수술적우세,치득림상추엄.
Objective To compare clinical outcomes of modified hand-assisted versus total laparoscopic splenectomy and esophagogastric devacularization for treatment of portal hypertension due to cirrhosis.Methods From Jan 2007 to Dec 2011,modified hand-assisted laparoscopic splenectomy plus esophagogastric devascularization (MHLSED) and total laparoscopic splenectomy and esophagogastric devascularization (LSED) were performed on 47 and 38 patients with portal hypertension due to cirrhosis,respectively.For the MHLESD group,we performed hand-assisted laparoscopic splenectomy first,then converted during operation to totally laparoscopic esophagogastric devascularization.The operating time,intra-operative blood loss,postoperative complications and postoperative hospitalization time were analyzed.Results MHLSED were performed on 47 patients successfully without any need to convert to open surgery,and LSED were performed on 36 patients with 2 patients having to convert to open surgery.The mean operative time [(154 ±32)min] and mean intra-operative blood loss [(115± 73)ml] in the HLSED group were significantly lower than the LSED group [(212±45)min and (172±57)ml,respectively].There was no mortality.There were no significant differences in the time period for gastrointestinal function to recover,postoperative hospital stay and overall complication rate between the two groups.Conclusions MHALSD is a relatively safe and efficacious treatment for portal hypertension due to cirrhosis.It combines the advantages of hand-assisted and totally laparoscopic operations.