Wang Wen-Jing, Tang Yong, Zhang Yu, Chen Qing
Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Huazhong Univ Sci Technolog Med Sci. 2015 Feb;35(1):99-104. doi: 10.1007/s11596-015-1396-3. Epub 2015 Feb 12.
This study was aimed to explore prevention and treatment of hemorrhage during laparoscopic splenectomy plus devascularization (LSD) for portal hypertension by modified and simplified operation. From June 2012 to June 2014, LSD was performed on 138 patients with portal hypertension. The patients were allocated into two groups: earlier stage (ES) group, in which 45 patients received traditional LSD from June 2012 to Sep. 2012; later stage (LS) group, in which 93 patients underwent modified LSD from Jan. 2013 to June 2014. Perioperative variables were compared between the two groups. Laparoscopic operations were successfully performed in all but two patients in ES group who were converted to laparotomy (total conversion rate: 1.4%). There was 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 time in the ES group was longer than that in the LS group (335.1 min vs. 201.3 min, P<0.05). LS group outperformed ES group in terms of blood loss (705.4 mL vs. 910.4 mL, P<0.05). The average operation time to oral diet intake after surgery (40.5 h vs. 50.3 h, P<0.05) and postoperative hospital stay (7.4 d vs. 9.0 days, P<0.05) were much less in the LS group than in the ES group. The overall complication rate (4.3 % vs. 11.1 %, P<0.05) and conversion rate (0% vs. 4.4%, P<0.05) were lower in the LS group than in the ES group. It was concluded that prevention and treatment of hemorrhage are the key points of LSD for portal hypertension. By creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus, the simplified and modified LSD can reduce hemorrhage and improve success of surgery dramatically, and splenomegaly and severe varices are not contraindications.
本研究旨在通过改良简化手术探索腹腔镜脾切除加去血管化术（LSD）治疗门静脉高压症术中出血的防治方法。2012年6月至2014年6月，对138例门静脉高压症患者施行LSD。将患者分为两组：早期（ES）组，45例患者于2012年6月至2012年9月接受传统LSD；晚期（LS）组，93例患者于2013年1月至2014年6月接受改良LSD。比较两组围手术期各项指标。ES组除2例患者中转开腹外（总中转率：1.4%），其余均成功完成腹腔镜手术。围手术期无死亡及再次手术病例，所有患者术后恢复良好，术后6个月随访无严重并发症，均康复出院。ES组平均手术时间长于LS组（335.1分钟 vs. 201.3分钟，P<0.05）。LS组在出血量方面优于ES组（705.4毫升 vs. 910.4毫升，P<0.05）。LS组术后从手术到开始经口进食的平均时间（40.5小时 vs. 50.3小时，P<0.05）及术后住院时间（7.4天 vs. 9.0天，P<0.05）均明显少于ES组。LS组总体并发症发生率（4.3% vs. 11.1%，P<0.05）及中转率（0% vs. 4.4%，P<0.05）低于ES组。结论：出血的防治是LSD治疗门静脉高压症的关键。通过在脾蒂上方及食管下段后方创建隧道，简化改良的LSD可显著减少出血，提高手术成功率，脾肿大及重度静脉曲张并非手术禁忌证。
