Yan Cao, Qiang Zeyuan, Jin Shuai, Yu Haibo
Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China.
Wideochir Inne Tech Maloinwazyjne. 2022 Jun;17(2):338-343. doi: 10.5114/wiitm.2022.114538. Epub 2022 Mar 16.
Laparoscopy splenectomy has been a preferred choice over open surgery, but limited studies dealing with laparoscopy splenectomy plus pericardial devascularization (LSPD) for elderly patients are available.
To assess the safety and long-term efficacy of spleen bed LSPD for elderly patients with portal hypertension.
A total of 132 elderly patients (age > 60 years) suffering from portal hypertension were operated on in the department. The patients were divided into 2 groups: those undergoing LSPD, and those undergoing open splenectomy plus pericardial devascularization (OSPD). Results and outcomes were compared retrospectively.
The clinical characteristics of the patients belonging to the two groups were studied. No significant difference between the characteristics of patients was reported and the clinical data revealed similarities in their characteristics. There was no significant difference in time taken for performing the operation (p > 0.05). The LSPD group showed less blood loss; started oral intake early; and the duration of post-operative hospital stay was also shorter (p < 0.05). Incidence rates of portal vein thrombosis; pancreatic leakage; pleural effusion; pulmonary infection; and delayed wound healing were also found to be lower in the LSPD group as compared to the OSPD group (p < 0.05). During a follow-up period of 6-70 months, no significant differences were found in the data for the two methods with respect to the incidence of rebleeding; hepatic encephalopathy; and survival (p > 0.05).
It was concluded that spleen bed LSPD is a safe and feasible procedure for treating elderly patients. It had a better clinical effect than that of OSPD.
与开放手术相比，腹腔镜脾切除术一直是首选，但针对老年患者的腹腔镜脾切除术加心包去血管化（LSPD）的研究有限。
评估脾床LSPD治疗老年门静脉高压症患者的安全性和长期疗效。
该科室共对132例年龄>60岁的老年门静脉高压症患者进行了手术。患者分为两组：接受LSPD的患者和接受开放脾切除术加心包去血管化（OSPD）的患者。对结果进行回顾性比较。
研究了两组患者的临床特征。报告显示患者特征之间无显著差异，临床数据显示其特征相似。手术时间无显著差异（p>0.05）。LSPD组出血量更少；更早开始经口进食；术后住院时间也更短（p<0.05）。与OSPD组相比，LSPD组门静脉血栓形成、胰漏、胸腔积液、肺部感染和伤口愈合延迟的发生率也更低（p<0.05）。在6至70个月的随访期内，两种方法在再出血发生率、肝性脑病和生存率方面的数据无显著差异（p>0.05）。
得出结论，脾床LSPD是治疗老年患者的一种安全可行的手术方法。其临床效果优于OSPD。
