Department of Hepatobiliary Surgery, Jiangyin Hospital Affiliated to Nantong University, Jiangyin, 214400, Jiangsu Province, China.
Department of Geriatric Medicine, Jiangyin Hospital Affiliated to Nantong University, Jiangyin, 214400, Jiangsu Province, China.
Int J Surg. 2020 Aug;80:79-83. doi: 10.1016/j.ijsu.2020.06.026. Epub 2020 Jun 30.
We compared laparoscopic splenectomy combined with oesophagogastric devascularisation vs. open splenectomy combined with oesophagogastric devascularisation in patients with portal hypertension secondary to liver cirrhosis.
This study included 192 patients diagnosed with portal hypertension and severe gastroesophageal varices at our hospital between January 2002 and December 2018; 62 patients underwent laparoscopic splenectomy combined with oesophagogastric devascularisation (laparoscopic group), and 130 patients underwent the open procedure (open group). The results and outcomes were compared retrospectively.
The median blood loss was significantly less in the laparoscopic group than in the open group (180 vs. 380 mL, P < 0.001). The length of hospitalisation was shorter (6 vs. 11 days, P < 0.001) and the complication rate was lower in the laparoscopic group (P < 0.001). The general complication rates were 23.8% and 4.8% (P < 0.001), and the surgical complication rates were 56.1% and 24.2% (P < 0.001) in the open and laparoscopic groups, respectively. During a postoperative follow-up period of 10-60 months, the incidence of oesophagogastric variceal rebleeding showed no significant difference between groups.
Laparoscopic splenectomy combined with oesophagogastric devascularisation is technically feasible and safe in selected patients. Compared with the open group, the laparoscopic group showed a less volume of blood loss, shorter length of hospitalisation, and fewer postoperative complications but similar long-term outcomes.
我们比较了腹腔镜脾切除术联合贲门周围血管离断术与开腹脾切除术联合贲门周围血管离断术治疗肝硬化门静脉高压症的疗效。
本研究纳入了 2002 年 1 月至 2018 年 12 月在我院诊断为门静脉高压症和重度胃食管静脉曲张的 192 例患者；其中 62 例行腹腔镜脾切除术联合贲门周围血管离断术（腹腔镜组），130 例行开腹手术（开腹组）。回顾性比较两组的手术结果和预后。
腹腔镜组的术中出血量明显少于开腹组（180 比 380ml，P<0.001）。腹腔镜组的住院时间更短（6 天比 11 天，P<0.001），并发症发生率更低（P<0.001）。腹腔镜组和开腹组的总体并发症发生率分别为 23.8%和 4.8%（P<0.001），手术并发症发生率分别为 56.1%和 24.2%（P<0.001）。术后 10-60 个月随访期间，两组食管胃静脉曲张再出血发生率无显著差异。
对于选择合适的患者，腹腔镜脾切除术联合贲门周围血管离断术在技术上是可行且安全的。与开腹组相比，腹腔镜组术中出血量更少，住院时间更短，术后并发症更少，但长期预后相似。
