完全腹腔镜脾切除加门奇静脉断流术与开腹手术的临床对照研究

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1、完全腹腔镜脾切除加门奇静脉断流术与开腹手术的临床对照研究作者：孙跃明作者单位：南京医科大学第一附属医院，江苏南京，210029【摘要】目的：比较完全腹腔镜脾切除加门奇静脉断流术与开腹手术的近期临床效果，并探讨完全腹腔镜的手术方法、可行性及安全性。方法：回顾分析2005年1月至2008年12月我院行完全腹腔镜与同期开腹脾切除加门奇静脉断流术各36例患者的临床资料。结果：所有手术均获成功，腹腔镜组平均手术时间稍长于开腹组［(195±58)minvs.(154±39)min］,而术中出血量［(392±165)mlvs.(693±204)ml］、术后下床活动时间［(41.3±

2、23.9)hvs.(103.7±33.4)h］＞排气时间［(2.1±0.9)dvs・(3・9±2.3)d］、住院时间［(13.6±2.3)dvs.(16.5±3.7)d］则明显少于开腹组。术后并发症如胰漏、肺部感染、切口感染及下肢深静脉血栓的发生率明显低于开腹组。两组住院费用差异无统计学意义。随访3〜36个月,两组消化道再出血率差异无统计学意义。结论：完全腹腔镜脾切除加门奇静脉断流术治疗门静脉高压症安全可行，疗效确切，近期疗效明显优于开腹手术，值得临床推广。【关键词】腹腔镜术，门奇静脉断流术，门静脉压;剖腹术;病例对照研究【Abstract】Objective:Toc

3、omparetheshorttermclinicaleffectoftotallylaparoscopicsplenectomyplusportalazygousdisconnectionwithlaparotomyonpatientssufferingfromportalhypertensionandtoexploretheprocedure,feasibilityandsafetyoftotallylaparoscopicsurgery.Methods:Theclinicaldataof36casesoftotallylaparoscopicsplenectomy

4、plusportalazygousdisconnectionand36casesoflaparotomyfromJan.2005toDec.2008wasretrospectivelyanalyzed.Results:Alloperationsweresuccessful.Themeanoperationtimewaslongerinthelaparoscopicgroupthanthatintheopengroup[(195±58)minvs.(154±39)min,P<0.05].Thelaparoscopicgroupdecreasedsignificantly

5、inbloodloss[(392±165)mlvs.(693±204)ml,P<0.01],postoperativeoffbedactivitytime[(41.3±23.9)hvs.(103.7+33.4)h,P<0.01],analexsufflationtime[(2.1±0.9)dvs.(3.9±2.3)d,P<0.05],hospitalization[(13.6±2.3)dvs.(16.5±3.7)d,P<0.05]andpostoperativecomplicationsuchaspancreaticleakage,pulmonaryinfection

6、,infectionofincisionalwoundanddeepvenousthrombosisoflowerlimb(P<0.05).Therewasnosignificantdifferencebetweenthetwogroupsinexpensesofhospitalizationandinuppergastrointestinalrebleedingin3to36months*followup(P>0.05).Conclusions:Theprocedureoftotallylaparoscopicsplenectomyplusportalazygous

7、disconnectionissafeandfeasible,withpromisingtherapeuticeffectandbettershorttermclinicaleffectthanlaparotomy,itisworthgeneralizing.【Keywords】Laparoscopy;Portalazygousdisconnection;Portalpressure;Laparotomy;Casecontrolstudies门静脉高压症是我国的常见病、多发病，病死率较高。食管静脉曲张破裂出血是门脉高压疾病最严重的并发症和死亡原因之一