手辅助与全腹腔镜选择性贲门周围血管离断术的安全性评价
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摘要
目的评价两种腹腔镜选择性贲门周围血管离断术治疗门静脉高压合并脾功能亢进的安全性。方法回顾性分析四川大学华西医院2014年1月至2018年11月60例门静脉高压合并脾功能亢进病人行腹腔镜选择性贲门周围血管离断术的临床资料,其中25例采用手辅助完成,35例全腹腔镜完成;对两组病人的围手术期数据进行比较。结果两组病人术前基线相似,手辅助组有1例中转开放,手辅助组手术时间短于全腹部腔镜组[(186.2±54.9) min比(238±66.7) min,P=0.04)];两组病人在术中失血量差异无统计学意义[(163.4±112.6) ml比(178.3±124.9) ml,P=0.08)];术后并发症发生率(44%比45%,P=0.89)及术后住院时间[(9.6±1.6) d比(10.3±2.1) d,P=0.84)]差异均无统计学意义。结论两种手术方式安全可行,手辅助腹腔镜组手术时间更短。
Objective To evaluate the safety of two laparoscopic splenectomy plus selective pericardial devascularization in the treatment of portal hypertension complicated with hypersplenism.Methods The clinical data of 60 patients with portal hypertension complicated with hypersplenism who underwent laparoscopic splenectomy plus selective pericardial devascularization were retrospectively analyzed from January 2014 to November 2018 in West China Hospital.Among them,25 patients were performed with hand-assisted splenectomy and 35 patients with total laparoscopic splenectomy.The perioperative data of the two groups were compared.Results The preoperative baseline characteristics were similar between the two groups.One patient in the hand-assisted group was transferred to laparotomy group.The operation time in the hand-assisted group was shorter than that in the total laparotomy group(186.2±54.9 d vs.238±66.7 d,P=0.04).There was no significant difference in intraoperative blood loss(163.4±112.6 ml vs.178.3±124.9 ml,P=0.08),postoperative complication rate(44% vs.45%,P=0.89) and postoperative hospital stay(9.6±1.6 d vs.10.3±2.1 d,P=0.84) between the two groups.Conclusion The results suggest that both surgical methods are safe and feasible with a shorter operation time in hand-assisted group.
Objective To evaluate the safety of two laparoscopic splenectomy plus selective pericardial devascularization in the treatment of portal hypertension complicated with hypersplenism.Methods The clinical data of 60 patients with portal hypertension complicated with hypersplenism who underwent laparoscopic splenectomy plus selective pericardial devascularization were retrospectively analyzed from January 2014 to November 2018 in West China Hospital.Among them,25 patients were performed with hand-assisted splenectomy and 35 patients with total laparoscopic splenectomy.The perioperative data of the two groups were compared.Results The preoperative baseline characteristics were similar between the two groups.One patient in the hand-assisted group was transferred to laparotomy group.The operation time in the hand-assisted group was shorter than that in the total laparotomy group(186.2±54.9 d vs.238±66.7 d,P=0.04).There was no significant difference in intraoperative blood loss(163.4±112.6 ml vs.178.3±124.9 ml,P=0.08),postoperative complication rate(44% vs.45%,P=0.89) and postoperative hospital stay(9.6±1.6 d vs.10.3±2.1 d,P=0.84) between the two groups.Conclusion The results suggest that both surgical methods are safe and feasible with a shorter operation time in hand-assisted group.
引文
[1] 卫生和计划生育委员会卫生公益性行业科研专项专家组.门静脉高压症食管胃曲张静脉破裂出血治疗技术规范专家共识2013版[J].中华消化外科杂志,2014,13(6):401-404.DOI:10.3760/cma.j.issn.1673-9752.2014.06.001.
[2] 杨连粤.门静脉高压症外科治疗的现状与展望[J].中华消化外科杂志,2015,14(1):10015-10016.DOI:10.3760/j.issn.1673-9752.2015.01.028.
[3] 杨镇.选择性贲门周围血管离断术的发展与手术技巧[J].中国实用外科杂志,2009,29(5):450-451.DOI:10.3969/j.issn.1005-6483.2004.07.003.
[4] Zhe C,Jian-wei L,Jian C,et al.Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism:a comparative study[J].J Gastrointest Surg,2013,17(4):654-659.DOI:10.1007/s11605-013-2150-4.
[5] 冯梦龙,钱玉元,潘定宇,等.腹腔镜与开腹脾切除加断流术的疗效对比[J].腹部外科,2017,30(1):61-64.DOI:10.3969/j.issn.1003-5591.2017.01.016.
[6] 杨镇.微创外科时代脾脏外科的现状与展望[J].腹部外科,2015,28(6):377-381.DOI:10.3969/j.issn.1003-5591.2015.06.001.
[7] Watanabe Y,Horiuchi A,Yoshida M,et al.Significance of laparoscopicsplenectomy in patients with hypersplenism[J].World J Surg,2007,31(3):549-555.DOI:10.1007/s00268-006-0504-8.
[8] Kawanaka H,Akahoshi T,Kinjo N,et al.Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension[J].J Am Coll Surg,2015,221(2):354-366.DOI:10.1016/j.jamcollsurg.2015.04.011.
[9] Jensen DM.Endoscopic screening for varices in cirrhosis:findings,implications,and outcomes[J].Gastroenterology,2002,122(6):1620.DOI:10.1053/gast.2002.33419.
[10] 中华外科学分会门静脉高压症学组.肝硬化门静脉高压症食管胃底静脉曲张破裂出血的诊治共识(2015版) [J].中华普通外科杂志,2016,31(2):167-170.DOI:10.3760/cma.j.issn.1007-631X.2016.02.032.
[11] Yamamoto N,Okano K,Oshima M,et al.Laparoscopic splenectomy for patients with liver cirrhosis:Improvement of liver function in patients with Child-Pugh class B[J].Surgery,2015,158(6):1538-1544.DOI:10.1016/j.surg.2015.05.008.
[12] 李永彬,王昕,王艺超,等.腹腔镜脾切除治疗门静脉高压症及术后并发症的危险因素分析[J].中华消化外科杂志,2013,12(11):841-845.DOI:10.3760/cma.j.issn.1673-9752.2013.11.008.
[13] Hiroshi H,Yoshida Y,Yasuhiro N,et al.New methods for the management of gastric varices[J].World J Gastroenterol,2006,12(37):5926-5931.DOI:10.3748/wjg.v12.i37.5926.
[14] de'Angelis N,Abdalla S,Lizzi V,et al.Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy[J].Surgery,2017,162(6):1219-1230.DOI:10.1016/j.surg.2017.07.016.
[15] van't Riet M,Burger J,van Muiswinkel J,et al.Diagnosis and treatment of portal vein thrombosis following splenectomy[J].Br J Surg,2000,87(9):1229-1233.DOI:10.1046/j.1365-2168.2000.01514.x.
[2] 杨连粤.门静脉高压症外科治疗的现状与展望[J].中华消化外科杂志,2015,14(1):10015-10016.DOI:10.3760/j.issn.1673-9752.2015.01.028.
[3] 杨镇.选择性贲门周围血管离断术的发展与手术技巧[J].中国实用外科杂志,2009,29(5):450-451.DOI:10.3969/j.issn.1005-6483.2004.07.003.
[4] Zhe C,Jian-wei L,Jian C,et al.Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism:a comparative study[J].J Gastrointest Surg,2013,17(4):654-659.DOI:10.1007/s11605-013-2150-4.
[5] 冯梦龙,钱玉元,潘定宇,等.腹腔镜与开腹脾切除加断流术的疗效对比[J].腹部外科,2017,30(1):61-64.DOI:10.3969/j.issn.1003-5591.2017.01.016.
[6] 杨镇.微创外科时代脾脏外科的现状与展望[J].腹部外科,2015,28(6):377-381.DOI:10.3969/j.issn.1003-5591.2015.06.001.
[7] Watanabe Y,Horiuchi A,Yoshida M,et al.Significance of laparoscopicsplenectomy in patients with hypersplenism[J].World J Surg,2007,31(3):549-555.DOI:10.1007/s00268-006-0504-8.
[8] Kawanaka H,Akahoshi T,Kinjo N,et al.Laparoscopic Splenectomy with Technical Standardization and Selection Criteria for Standard or Hand-Assisted Approach in 390 Patients with Liver Cirrhosis and Portal Hypertension[J].J Am Coll Surg,2015,221(2):354-366.DOI:10.1016/j.jamcollsurg.2015.04.011.
[9] Jensen DM.Endoscopic screening for varices in cirrhosis:findings,implications,and outcomes[J].Gastroenterology,2002,122(6):1620.DOI:10.1053/gast.2002.33419.
[10] 中华外科学分会门静脉高压症学组.肝硬化门静脉高压症食管胃底静脉曲张破裂出血的诊治共识(2015版) [J].中华普通外科杂志,2016,31(2):167-170.DOI:10.3760/cma.j.issn.1007-631X.2016.02.032.
[11] Yamamoto N,Okano K,Oshima M,et al.Laparoscopic splenectomy for patients with liver cirrhosis:Improvement of liver function in patients with Child-Pugh class B[J].Surgery,2015,158(6):1538-1544.DOI:10.1016/j.surg.2015.05.008.
[12] 李永彬,王昕,王艺超,等.腹腔镜脾切除治疗门静脉高压症及术后并发症的危险因素分析[J].中华消化外科杂志,2013,12(11):841-845.DOI:10.3760/cma.j.issn.1673-9752.2013.11.008.
[13] Hiroshi H,Yoshida Y,Yasuhiro N,et al.New methods for the management of gastric varices[J].World J Gastroenterol,2006,12(37):5926-5931.DOI:10.3748/wjg.v12.i37.5926.
[14] de'Angelis N,Abdalla S,Lizzi V,et al.Incidence and predictors of portal and splenic vein thrombosis after pure laparoscopic splenectomy[J].Surgery,2017,162(6):1219-1230.DOI:10.1016/j.surg.2017.07.016.
[15] van't Riet M,Burger J,van Muiswinkel J,et al.Diagnosis and treatment of portal vein thrombosis following splenectomy[J].Br J Surg,2000,87(9):1229-1233.DOI:10.1046/j.1365-2168.2000.01514.x.