中华腔镜外科杂志（电子版）
中華腔鏡外科雜誌（電子版）
중화강경외과잡지（전자판）
CHINESE JOURNAL OF LAPAROSCOPIC SURGERY ( ELECTRONIC EDITION)
2015年
2期
12-17
,共6页
王文静%唐勇%冯贤松%万赤丹%陈庆
王文靜%唐勇%馮賢鬆%萬赤丹%陳慶
왕문정%당용%풍현송%만적단%진경
腹腔镜%脾切除术%贲门周围血管离断术%门静脉高压症
腹腔鏡%脾切除術%賁門週圍血管離斷術%門靜脈高壓癥
복강경%비절제술%분문주위혈관리단술%문정맥고압증
Laparoscopy%Splenectomy%Pericardial devascularization%Portal hypertension
目的：通过改良腹腔镜脾切除及贲门周围血管离断术（LSPD）对手术的简化和改进，探讨其在门静脉高压症患者中应用的安全性和有效性。方法自2012年6月至2015年1月华中科技大学同济医学院附属协和医院肝胆外科149例门静脉高压症患者行 LSPD，按时间及脾大小分组，分别比较两组患者的临床资料：A 组46例行传统 LSPD 的早期病例与103例行改良 LSPD 的后期病例；B 组103例后期病例中脾长径大于20 cm 的39例巨脾病例与脾长径小于20 cm 的64例非巨脾病例。结果A 组早期病例中有3例及后期病例中有1例中转开腹手术，其余145例均顺利完成LSPD，无围术期死亡或二次手术，术后均康复出院，随访6个月内无明显并发症。早期病例的平均手术时间长于后期病例（344．2 min vs 214．3 min，P ＜0．05），而术中出血量多于后期病例（907．4 ml vs 715．3 ml，P ＜0．05）。后期病例术后进食时间（7．6 d vs 9．1 d，P ＜0．05）及术后住院时间（41．3 h vs 51．2 h，P ＜0．05）均短于早期病例。后期病例术后并发症发生率（4．85％ vs 10．8％，P ＜0．05）及手术中转率（0．97％ vs 6．52％，P ＜0．05）明显少于早期病例。B 组巨脾病例中有1例中转开腹手术，其余102例均顺利完成改良 LSPD，巨脾病例的平均手术时间长于非巨脾病例（246．5 min vs 184．3 min， P ＜0．05），而术中出血量（876．4 ml vs 492．5 ml，P ＜0．05）及手术中转率（2．56％ vs 0％，P ＜0．05）多于非巨脾病例。两者在术后进食时间（41．2 h vs 40．4 h）、术后住院时间（7．9 d vs 7．1 d ）及并发症发生率（5．13％ vs 4．68％）比较，差异无统计学意义（P ＞0．05）。结论改良 LSPD 通过建立脾蒂隧道和食管后隧道的技术，对手术进行简化和改进可以减少术中出血，显著提高手术成功率，巨脾及重度静脉曲张不是门静脉高压症行腹腔镜手术的禁忌证。
目的：通過改良腹腔鏡脾切除及賁門週圍血管離斷術（LSPD）對手術的簡化和改進，探討其在門靜脈高壓癥患者中應用的安全性和有效性。方法自2012年6月至2015年1月華中科技大學同濟醫學院附屬協和醫院肝膽外科149例門靜脈高壓癥患者行 LSPD，按時間及脾大小分組，分彆比較兩組患者的臨床資料：A 組46例行傳統 LSPD 的早期病例與103例行改良 LSPD 的後期病例；B 組103例後期病例中脾長徑大于20 cm 的39例巨脾病例與脾長徑小于20 cm 的64例非巨脾病例。結果A 組早期病例中有3例及後期病例中有1例中轉開腹手術，其餘145例均順利完成LSPD，無圍術期死亡或二次手術，術後均康複齣院，隨訪6箇月內無明顯併髮癥。早期病例的平均手術時間長于後期病例（344．2 min vs 214．3 min，P ＜0．05），而術中齣血量多于後期病例（907．4 ml vs 715．3 ml，P ＜0．05）。後期病例術後進食時間（7．6 d vs 9．1 d，P ＜0．05）及術後住院時間（41．3 h vs 51．2 h，P ＜0．05）均短于早期病例。後期病例術後併髮癥髮生率（4．85％ vs 10．8％，P ＜0．05）及手術中轉率（0．97％ vs 6．52％，P ＜0．05）明顯少于早期病例。B 組巨脾病例中有1例中轉開腹手術，其餘102例均順利完成改良 LSPD，巨脾病例的平均手術時間長于非巨脾病例（246．5 min vs 184．3 min， P ＜0．05），而術中齣血量（876．4 ml vs 492．5 ml，P ＜0．05）及手術中轉率（2．56％ vs 0％，P ＜0．05）多于非巨脾病例。兩者在術後進食時間（41．2 h vs 40．4 h）、術後住院時間（7．9 d vs 7．1 d ）及併髮癥髮生率（5．13％ vs 4．68％）比較，差異無統計學意義（P ＞0．05）。結論改良 LSPD 通過建立脾蒂隧道和食管後隧道的技術，對手術進行簡化和改進可以減少術中齣血，顯著提高手術成功率，巨脾及重度靜脈麯張不是門靜脈高壓癥行腹腔鏡手術的禁忌證。
목적：통과개량복강경비절제급분문주위혈관리단술（LSPD）대수술적간화화개진，탐토기재문정맥고압증환자중응용적안전성화유효성。방법자2012년6월지2015년1월화중과기대학동제의학원부속협화의원간담외과149례문정맥고압증환자행 LSPD，안시간급비대소분조，분별비교량조환자적림상자료：A 조46례행전통 LSPD 적조기병례여103례행개량 LSPD 적후기병례；B 조103례후기병례중비장경대우20 cm 적39례거비병례여비장경소우20 cm 적64례비거비병례。결과A 조조기병례중유3례급후기병례중유1례중전개복수술，기여145례균순리완성LSPD，무위술기사망혹이차수술，술후균강복출원，수방6개월내무명현병발증。조기병례적평균수술시간장우후기병례（344．2 min vs 214．3 min，P ＜0．05），이술중출혈량다우후기병례（907．4 ml vs 715．3 ml，P ＜0．05）。후기병례술후진식시간（7．6 d vs 9．1 d，P ＜0．05）급술후주원시간（41．3 h vs 51．2 h，P ＜0．05）균단우조기병례。후기병례술후병발증발생솔（4．85％ vs 10．8％，P ＜0．05）급수술중전솔（0．97％ vs 6．52％，P ＜0．05）명현소우조기병례。B 조거비병례중유1례중전개복수술，기여102례균순리완성개량 LSPD，거비병례적평균수술시간장우비거비병례（246．5 min vs 184．3 min， P ＜0．05），이술중출혈량（876．4 ml vs 492．5 ml，P ＜0．05）급수술중전솔（2．56％ vs 0％，P ＜0．05）다우비거비병례。량자재술후진식시간（41．2 h vs 40．4 h）、술후주원시간（7．9 d vs 7．1 d ）급병발증발생솔（5．13％ vs 4．68％）비교，차이무통계학의의（P ＞0．05）。결론개량 LSPD 통과건립비체수도화식관후수도적기술，대수술진행간화화개진가이감소술중출혈，현저제고수술성공솔，거비급중도정맥곡장불시문정맥고압증행복강경수술적금기증。
Objective This study is aimed to explore the efficacy and safety of modified laparoscopic splenectomy plus devascularization (LSPD)for portal hypertension by modified and simplified operation.Methods From Jun.2012 to Jan.2015,LSPD was performed on 149 patients with portal hypertension in our medical center.The patients were allocated into two groups by date of operation and length of spleens.Group A:46 cases from Jun.2012 to Dec.2012 received traditional LSPD were categorized as group earlier stage (ES);103 cases from Jan.2013 to Jan.2015 underwent modified LSPD were categorized as group later stage (LS).Group B:of 103 cases in LS,39 cases with spleens larger than 20 cm were categorized as MS (group massive splenomegaly;the other 64 cases with spleens less than 20 cm were categorized as NMS (group non-massive splenomegaly).Perioperative variables of the patients were compared.Results Group A:Laparoscopic operations were successfully fulfilled in all but three patients in ES and one patient in LS who were converted to laparotomy .There is no perioperative death or reoperation, and all patients recovered and were discharged from hospital with no serious complications in the six months of postoperative follow-up.The average operative time in the group ES was longer than that in the group LS (344.2 min vs 214.3 min,P <0.05 ).In terms of blood loss (907.4 ml vs 715.3 ml,P <0.05 ), operation in the LS also outperformed that in the ES.The average time of oral diet intake (41.3 h vs 51.2 h, P <0.05)and postoperative hospital stay (7.6 d vs 9.1 d,P <0.05)were much less in the group LS than in the group ES.The overall complication rate (4.85% vs 10.8% P <0.05)and conversion rate (0.97% vs 6.52%,P <0.05)were lower in the group LS than in the group ES.Group B:except one patient in MS who was converted to laparotomy,the other 102 cases were all performed modified LSPD successfully.Compared to NMS,the average time of MS was longer(246.5 min vs 184.3 min,P <0.05),there were more blood loss (876.4 ml vs 492.5 ml,P <0.05)and higher conversion rate(2.56% vs 0%,P <0.05)in MS.There were no significant differences between the two groups in average time of oral diet intake(41.2 h vs 40.4 h, P >0.05),postoperative hospital stay(7.9 d vs 7.1 d,P >0.05)and overall complication rate(5.13% vs 4.68%,P >0.05).Conclusion Modified LSPD simplify and modify the procedure by creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus,which can reduce hemorrhage and improve success of surgery dramatically.It is concluded that splenomegaly and severe varices are not contraindications.
