手助腹腔镜脾切除门奇静脉断流术与开腹手术的临床对比研究

目的探讨手助腹腔镜脾切除加门-奇静脉阻断术的可行性及优越性。方法 2008年1月至2009年6月,对29例肝硬化并门静脉高压患者行手助腹腔镜脾切除加门奇静脉阻断术（腹腔镜组）,与同期29例门静脉高压患者行开腹手术（开腹组）进行对比分析。比较2组的手术时间、术中出血量、术后中度发热及高热时间、术后排气时间、术后切口疼痛用止痛药时间、术后住院时间、术后切口感染率、术后再出血率和术后总胆红素升高情况。结果 29例手助腹腔镜脾切除加门-奇静脉阻断术获得成功。与开腹组比较,手助腹腔镜组手术时间短、术中出血少、术后肛门排气时间早、术后发热时间短、术后疼痛时间短、术后住院时间短、切口感染率低（均P〈0.05）。术后1年再出血率2组无明显差别,术后总胆红素升高情况2组无明显差别（均P〉0.05）。结论手助腹腔镜脾切除加门-奇静脉阻断术是安全可行的,且比开腹手术有优越性。

Comparison of Hand-assisted Laparoscopic Splenectomy Plus Porta-agygous Devascularization and Open Splenectomy

Objective To explore the feasibility and advantage of hand-assisted laparoscopic splenectomy plus porta-agygous devascularization.Methods Fifty-eight patients with hepatocirrhosis and portal hypertension underwent either hand-assisted laparoscopic splenectomy plus porta-agygous devascularization（29 patients） or open splenectomy（29 patients）.Parameters,including operating time,blood loss,duration of fever,postoperative exhaust time,duration of postoperative pain,length of postoperative hospital stay,wound infection rate,recurrence of hemorrhage and rise in total bilirubin were measured.Results Hand-assisted laparoscopic splenectomy plus porta-agygous devascularization was successful in all 29 patients.Compared with open surgery,hand-assisted laparoscopic splenectomy plus porta-agygous devascularization decreased operation time,blood loss,duration of fever,duration of postoperative pain,length of postoperative hospital stay and wound infection rate,and accelerated postoperative exsufflation（P0.05）.There were no significances in hemorrhage recurrence and bilirubin rise between the two procedures 1 year after operation（P0.05）.Conclusion Hand-assisted laparoscopic splenectomy plus porta-agygous devascularization is feasible and safe in patients with hepatocirrhosis and portal hypertension,and offers advantages over open surgery.