Lin Jie, Liu Qingbo, Liang Zhiqiang, He Wei, Chen Jianping, Ma Jing, Gu Chichang, Wang Weidong
Second Department of General Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, China.
Wideochir Inne Tech Maloinwazyjne. 2019 Apr;14(2):187-194. doi: 10.5114/wiitm.2018.80297. Epub 2018 Dec 10.
The role of laparoscopic selective esophagogastric devascularization and splenectomy (LSEGDS) in the treatment of esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension has not been well studied.
To investigate the safety and efficacy of LSEGDS for esophagogastric variceal bleeding and hypersplenism in patients with cirrhotic portal hypertension.
From May 2011 to December 2014, 74 patients with portal hypertension resulting from liver cirrhosis underwent surgery for gastroesophageal variceal bleeding and hypersplenism. Forty-one of these patients underwent laparoscopic esophagogastric devascularization and splenectomy (LEGDS), and the others underwent LSEGDS. A retrospective comparative analysis of clinical data was conducted between the two groups, including clinical characteristics, laboratory data, operative morbidity and mortality, and outcomes of follow-up.
The operation was completed successfully in all the patients, except that conversion was required in one patient in the LEGDS group. The operating time was similar in both groups (p = 0.579). The intraoperative blood loss was lower in the LSEGDS group (p = 0.011). Postoperative complications showed no significant difference between the two groups regarding mortality rate, pleural effusion, pancreatic injury, pulmonary infection, liver dysfunction, or postoperative abdominal bleeding. Postoperative platelet counts increased significantly more in the LEGDS group than in the LSEGDS group (p = 0.004). There were no significant differences in the long-term follow-up data, such as incidence of rebleeding, portal vein thrombosis, hepatic encephalopathy and survival (p > 0.05).
The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins.
腹腔镜选择性食管胃去血管化联合脾切除术（LSEGDS）在肝硬化门静脉高压症患者食管胃静脉曲张出血和脾功能亢进治疗中的作用尚未得到充分研究。
探讨LSEGDS治疗肝硬化门静脉高压症患者食管胃静脉曲张出血和脾功能亢进的安全性和有效性。
2011年5月至2014年12月，74例肝硬化所致门静脉高压症患者接受了食管胃静脉曲张出血和脾功能亢进手术。其中41例患者接受了腹腔镜食管胃去血管化联合脾切除术（LEGDS），其余患者接受了LSEGDS。对两组患者的临床资料进行回顾性对比分析，包括临床特征、实验室数据、手术发病率和死亡率以及随访结果。
所有患者手术均成功完成，LEGDS组有1例患者需要中转开腹。两组手术时间相似（p = 0.579）。LSEGDS组术中出血量更低（p = 0.011）。两组术后并发症在死亡率、胸腔积液、胰腺损伤、肺部感染、肝功能障碍或术后腹腔出血方面无显著差异。LEGDS组术后血小板计数升高幅度显著大于LSEGDS组（p = 0.004）。长期随访数据，如再出血发生率、门静脉血栓形成、肝性脑病和生存率方面无显著差异（p > 0.05）。
LSEGDS是治疗肝硬化门静脉高压症的一种安全有效的方法，尤其适用于食管旁静脉可见的患者。
