Laparoscopic esophagogastric devascularization for portal hypertension

中华普通外科杂志 Pub Date : 2019-12-25 DOI:10.3760/CMA.J.ISSN.1007-631X.2019.12.003

Yafeng Chen, Xilin Du, Jianguo Lu, Jikai Yin, Dong Wang, L. Zang, R. Dong

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Abstract

Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension. Methods In this study, 205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group) and 70 patients undergoing open surgery(OSD group). Results Operation time, intraoperative blood loss, intraoperative blood infusion, time of postoperative abdominal drainage-tube removal, time of gastrointestinal function recovery and duration of hospital stay were respectively (150±37)min, (223±129)ml, (91±138)ml, (4.0±1.0)d, (33±9)h, (5.6±1.0)d in the LSD group, (183±42)min, (346±131)ml, (214±182)ml, (5.5±1.3)d, (42±14)h, (7.5±1.4)d in the OSD group, with statistically significant differences between groups(t=-2.203, -4.980, -2.830, -5.553, -2.307, -6.635, all P<0.05). The main complications included pancreatic fistula, intra-abdominal bleeding, intra-abdominal infection, pulmonary infection, refractory ascites, portal vein system thrombosis and incision infection, and there were respectively 0, 1, 2, 2, 3, 13, 0 in the LSD group and 3, 4, 6, 6, 7, 14, 3 in the OSD group, with statistically significant differences between groups (χ2=5.872, 4.792, 6.179, 6.179, 6.010, 4.335, 5.872, all P<0.05). All the 205 patients received follow-up for a median time of 38 months(12-72 months). Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months. Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe, feasible and effective. Key words: Hypertension, portal; Laparoscopy; Splenectomy

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腹腔镜食管胃断流术治疗门静脉高压症

目的评价腹腔镜下门静脉高压症脾切除术及心包断流术的疗效。方法本研究将2013年1月至2018年1月在空军医科大学第二医院接受脾切除和心包断流术的205例患者分为135例腹腔镜手术患者（LSD组）和70例开放手术患者（OSD组）。结果LSD组手术时间为（150±37）min，术中出血量为（223±129）ml，胃肠功能恢复时间为（91±138）ml，住院时间为（4.0±1.0）d，（33±9）h，（5.6±1.0）h，LSD组为（183±42）min，（346±131）ml，（214±182）ml，OSD组为（7.5±1.4）d，组间差异有统计学意义（t=-2.203、-4.980、-2.830、-5.53、-2.307、-6.635，均P<0.05）。主要并发症包括胰瘘、腹腔出血、腹腔感染、肺部感染、顽固性腹水、门静脉系统血栓形成和切口感染，LSD组为0，OSD组为3、4、6、6、7、14、3，组间差异有统计学意义（χ2=5.872、4.792、6.179、6.179，6.010、4.335、5.872，均P<0.05）。胃镜检查显示术后6个月食管和胃静脉曲张有所改善。结论腹腔镜脾切除加心包断流术治疗门静脉高压症安全、可行、有效。关键词：高血压，门脉；腹腔镜；脾切除术

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中华普通外科杂志

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