Zheng Shunzhen, Sun Ping, Liu Xihan, Li Guangbing, Gong Wei, Liu Jun
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong University.
Blood Station of Jinan.
Medicine (Baltimore). 2018 Dec;97(50):e13703. doi: 10.1097/MD.0000000000013703.
Many patients in China have portal hypertension secondary to liver cirrhosis. Splenectomy and devascularization have become an efficacious surgical procedure for portal hypertension, and has been recommended in China as the first choice for the treatment of portal hypertension for a long time. As a result of advances in laparoscopic equipment and techniques, splenectomy and esophagogastric devascularization have been carried out with laparoscope.From January 2012 to December 2017, 453 patients who were diagnosed with portal hypertension and serious gastroesophageal varices received surgical management in our institution. 250 patients chose laparoscopic splenectomy and esophagogastric devascularization and 203 underwent open splenectomy and esophagogastric devascularization.We retrospectively analyzed the perioperative data and follow-up data of these patients. The operation time of laparoscopic group was longer than open group (P ≤ .001). Intraoperative blood loss was less (P ≤ .001), the passing of flatus was earlier (P = .042), and postoperative hospital stay was shorter (P = .001) in the laparoscopic group. During postoperative follow-up of 4 to 75 months, the incidence of esophagogastric variceal rebleeding, encephalopathy, and secondary liver cancer showed no significant differences.Laparoscopic splenectomy and esophagogastric devascularization were safe and more effective than open surgery for portal hypertension and gastroesophageal varices.
在中国，许多患者患有继发于肝硬化的门静脉高压症。脾切除及断流术已成为治疗门静脉高压症的一种有效外科手术，长期以来在中国被推荐为治疗门静脉高压症的首选方法。随着腹腔镜设备和技术的进步，已开展了腹腔镜下脾切除及食管胃断流术。2012年1月至2017年12月，453例被诊断为门静脉高压症和严重食管胃静脉曲张的患者在我院接受了手术治疗。250例患者选择了腹腔镜脾切除及食管胃断流术，203例接受了开腹脾切除及食管胃断流术。我们回顾性分析了这些患者的围手术期数据和随访数据。腹腔镜组的手术时间比开腹组更长（P≤.001）。腹腔镜组术中出血量更少（P≤.001），肠鸣音恢复更早（P =.042），术后住院时间更短（P =.001）。在术后4至75个月的随访期间，食管胃静脉曲张再出血、肝性脑病和继发性肝癌的发生率无显著差异。对于门静脉高压症和食管胃静脉曲张，腹腔镜脾切除及食管胃断流术比开腹手术更安全、更有效。
