CAJ | 학술논문

目的：探讨腹腔镜下脾切除联合内镜下食管曲张静脉套扎术在肝硬化门静脉高压症中的应用价值。方法本前瞻性研究对象为2011年9月至2014年9月在中山大学附属第三医院岭南医院行脾切除联合内镜下曲张静脉套扎术的63例肝硬化门静脉高压症患者。根据脾切除手术方式的不同，将患者随机分为腹腔镜组和开腹组。其中腹腔镜组28例，男25例，女3例；年龄40～69岁，中位年龄55岁。开腹组35例，男32例，女3例；年龄43～69岁，中位年龄53岁。所有患者均签署知情同意书，符合医学伦理学规定。两组患者切脾后均术中行胃镜下食管曲张静脉套扎术。观察两组患者的手术时间、术中出血量、住院天数、治疗费用、术后并发症发生率。两组患者观察指标比较采用t检验，率的比较采用Fisher确切概率法。结果两组患者均成功完成手术。腹腔镜组患者的手术时间、术中出血量分别为（113±8）min、（204±52）ml，开腹组相应为（106±6）min、（226±63）ml，差异无统计学意义（t=1.97，-0.75；P>0.05）。腹腔镜组患者的住院天数、治疗费用分别为（6.0±1.2）d、（3.5±0.3）万元，明显少于开腹组的（11.2±2.7）d、（4.5±0.1）万元（t=-4.87，-6.81；P<0.05）。腹腔镜组患者术后出现并发症8例，其中门静脉血栓7例，复发出血1例；开腹组患者术后出现并发症17例，其中门静脉血栓10例，伤口脂肪液化7例。腹腔镜组的伤口脂肪液化率明显低于开腹组（P=0.035）。结论腹腔镜脾切除联合内镜下食管曲张静脉套扎术可取得与开腹手术类似的疗效，且具有创伤小、恢复快、伤口并发症少的优势，同时能够缩短住院时间，减少总治疗费用。
목적：탐토복강경하비절제연합내경하식관곡장정맥투찰술재간경화문정맥고압증중적응용개치。방법본전첨성연구대상위2011년9월지2014년9월재중산대학부속제삼의원령남의원행비절제연합내경하곡장정맥투찰술적63례간경화문정맥고압증환자。근거비절제수술방식적불동，장환자수궤분위복강경조화개복조。기중복강경조28례，남25례，녀3례；년령40～69세，중위년령55세。개복조35례，남32례，녀3례；년령43～69세，중위년령53세。소유환자균첨서지정동의서，부합의학윤리학규정。량조환자절비후균술중행위경하식관곡장정맥투찰술。관찰량조환자적수술시간、술중출혈량、주원천수、치료비용、술후병발증발생솔。량조환자관찰지표비교채용t검험，솔적비교채용Fisher학절개솔법。결과량조환자균성공완성수술。복강경조환자적수술시간、술중출혈량분별위（113±8）min、（204±52）ml，개복조상응위（106±6）min、（226±63）ml，차이무통계학의의（t=1.97，-0.75；P>0.05）。복강경조환자적주원천수、치료비용분별위（6.0±1.2）d、（3.5±0.3）만원，명현소우개복조적（11.2±2.7）d、（4.5±0.1）만원（t=-4.87，-6.81；P<0.05）。복강경조환자술후출현병발증8례，기중문정맥혈전7례，복발출혈1례；개복조환자술후출현병발증17례，기중문정맥혈전10례，상구지방액화7례。복강경조적상구지방액화솔명현저우개복조（P=0.035）。결론복강경비절제연합내경하식관곡장정맥투찰술가취득여개복수술유사적료효，차구유창상소、회복쾌、상구병발증소적우세，동시능구축단주원시간，감소총치료비용。
ObjectiveTo investigate the application value of laparoscopic splenectomy combined with endoscopic variceal ligation in cirrhosis and portal hypertension.MethodsSixty-three patients with cirrhosis and portal hypertension undergoing laparoscopic splenectomy combined with endoscopic variceal ligation in Lingnan Hospital, the Third Afifliated Hospital of Sun Yat-sen University between September 2011 and September 2014 were included in the prospective study. The patients were randomized into the laparoscopy group and the laparotomy group according to different surgical procedures. Among the 28 patients in the laparoscopy group, 25 were males and 3 were females with the age ranging from 40 to 69 years old and the median of 55 years old. Among the 35 patients in the laparotomy group, 32 were males and 3 were females with the age ranging from 43 to 69 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients of two groups underwent endoscopic variceal ligation during the splenectomy. The duration of operation, intraoperative blood loss, length of hospital stay, treatment costs and incidence of postoperative complications of two groups were observed. The comparison of the observed indexes of two groups was conducted usingt test and the rate comparison was conducted using Fisher's exact test.ResultsAll the patients completed the surgery successfully. The duration of operation and the intraoperative blood loss were (113±8) min and (204±52) ml for the laparoscopy group, and were (106±6) min and (226±63) ml for the laparotomy group where no significant difference was observed (t=1.97,-0.75;P>0.05). The length of hospital stay and treatment costs of laparoscopy group were (6.0±1.2) and (35 000±3 000) RMB, which were signiifcantly lower than (11.2±2.7) and (45 000±1 000) RMB of laparotomy group (t=-4.87,-6.81;P<0.05). Eight patients in the laparoscopy group developed complications, among them, 7 were with portal venous thrombosis and 1 was with recurrent hemorrhage. Seventeen patients in the laparotomy group developed complications, among them, 10 were with portal venous thrombosis and 7 were with fat liquefaction of incisions. The incidence of fat liquefaction of incisions in laparoscopy group was signiifcantly lower than that of the laparotomy group (P=0.035).ConclusionLaparoscopic splenectomy combined with endoscopic variceal ligation can achieve the similar curative effect with laparotomy and has the advantages of small operational wound, quick recovery, less complications, as well as shorter length of hospital stay and lower total treatment costs.