完全腹腔镜贲门周围血管离断术联合脾切除术对CPH的效果分析

刘东亮 罗红杰 罗磊 季春勇

郑州大学附属郑州中心医院肝胆胰微创外科

摘要：目的：探究完全腹腔镜贲门周围血管离断术联合脾切除术治疗肝硬化门静脉高压症（CPH）患者的效果。方法：选取113例CPH患者，将其随机分为两组。对照组56例给予开腹贲门周围血管离断术联合脾切除术，观察组57例给予完全腹腔镜贲门周围血管离断术联合脾切除术，比较两组治疗效果。结果：观察组术后下床时间和住院时间均短于对照组；术中出血量、术后皮质醇、促肾上腺皮质激素、肾上腺素水平及并发症发生率均低于对照组；手术时间长于对照组，差异均有统计学意义（P＜0.05）。术后两组患者ALT、AST、ALB、TBiL水平比较，差异均无统计学意义（P＞0.05）。结论：完全腹腔镜贲门周围血管离断术联合脾切除术治疗肝硬化门静脉高压症可有效减少应激反应的发生和术中出血量，且并发症风险低。

关键词：完全腹腔镜贲门周围血管离断术;脾切除术;肝硬化门静脉高压症;

Effects of total laparoscopic pericardia devascularization and splenectomy on CPH

LIU Dongliang,LUO Hongjie,LUO Lei,JI Chunyong.(Dept. of Hepatobiliary & PancreaticMinimally Invasive Surgery,the Affiliated Zhengzhou Central Hospital of Zhengzhou University,Zhengzhou 450000,China)

Abstract Objective: To investigate the effects of total laparoscopic pericardia devascularization combined with splenectomy on patients with cirrhotic portal hypertension(CPH). Methods: 113 CPH patients were selected and randomized into two groups. 56 cases in the control group were treated with laparoscopic pericardia devascularization combined with splenectomy, while 57 cases in the observation group were treated with total laparoscopy combined with splenectomy. Then, the clinical efficacy was compared between patients in both groups. Results: The time of getting out of bed after operation and hospital stay was shorter than that of the control group, the intraoperative blood loss, postoperative cortisol, ACTH,epinephrine levels and the incidence of complications in the observation group were all lower than those in the control group, and the operation time was longer than that in the control group, which were of statistical significances(P<0.05); and there were no significant differences in ALT, AST, ALB and TBiL levels between the two groups after operation(P>0.05). Conclusion: For CPH patients, total laparoscopic pericardia devascularization combined with splenectomy can effectively reduce the occurrence of patients′stress response, intraoperative blood loss and the risks of complications.

Keywords: total laparoscopy pericardia devascularization; splenectomy; cirrhotic portal hypertension(CPH)

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