中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 9
Sep.  2016
Turn off MathJax
Article Contents

Clinical effect of laparoscopic splenectomy combined with esophagogastric devascularization in treatment of liver cirrhosis with portal hypertension

DOI: 10.3969/j.issn.1001-5256.2016.09.022
  • Published Date: 2016-09-20
  • Objective To investigate the effect and safety of laparoscopic splenectomy( LS) combined with esophagogastric devascularization( ED) in the treatment of esophagogastric variceal bleeding and severe hypersplenism. Methods A retrospective analysis was performed for 68 patients with cirrhotic portal hypertension who visited The Central Hospital of Hanzhong from June 2012 to June 2013. The patients were divided into LS + ED group and open splenectomy( OS) + ED group,with 34 patients in each group. The clinical indices,complications,degree of gastric varices before and after surgery,and changes in Child- Pugh score for liver function were compared between the two groups. The t- test was used for comparison of continuous data between groups,and the chi- square test or the Fisher's exact test was used for comparison of categorical data between groups. Results The LS + ED group had a significantly lower postoperative drainage volume,significantly less intraoperative blood loss,a significantly shorter length of postoperative hospital stay,and a significantly shorter postoperative ventilation time than the OS + ED group( t =- 3. 144,- 2. 536,- 4. 151,and- 2. 671,P = 0. 003,0. 015,0. 001,and 0. 002),while the improvements in the degree of gastric varices and Child- Pugh score for liver function showed no significant differences between the two groups( both P > 0. 05). Conclusion LS combined with ED can significantly reduce intraoperative blood loss,postoperative drainage volume,time of passage of gas by anus after surgery,and length of postoperative hospital stay,and therefore,it is a safe,feasible,and effective method for the treatment of portal hypertension.

     

  • loading
  • [1]NI YB,GAO PJ,WANG D,et al.Esophagogastric devascularization without splenectomy in portal hypertension:safe and effective?[J].Hepatobiliary Pancreat Dis Int,2015,14(3):276-280.
    [2]HAN K,KIM JH,KO GY,et al.Treatment of hepatocellular carcinoma with portal venous tumor thrombosis:a comprehensive review[J].World J Gastroenterol,2016,22(1):407.
    [3] SCHETTINI AV,PINHEIRO RS,PESCATORE P,et al.Modified sugiura operation for idiopathic portal hypertension with bleeding oesophageal varices.A case report[J].Acta Chir Belg,2014,115(3):237-240.
    [4]CHENG Z,LI J,CHEN J,et al.Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases[J].J Laparoendosc Adv Surg Tech A,2014,24(9):612-616.
    [5]JIANG XZ,ZHAO SY,LUO H,et al.Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension[J].World J Gastroenterol,2009,15(27):3421.
    [6]ALEXAKIS N,DARDAMANIS D,ALBANOPOULOS K,et al.Incidence,risk factors,and outcome of portal vein thrombosis after laparoscopic-assisted splenectomy inβ-thalassemia patients:a prospective exploratory study[J].J Laparoendosc Adv Surg Tech A,2013,23(2):123-128.
    [7]CHEN GM,ZHANG Y.Advances in the application of various surgical procedures of laparoscopic splenectomy in treatment of portal hypertension[J].J Ningxia Med Univ,2015,37(6):721-724.(in Chinese)陈官明,张岩.不同腹腔镜脾脏切除手术方式在治疗门脉高压症中的应用进展[J].宁夏医科大学学报,2015,37(6):721-724.
    [8]HAMA T,TAKIFUJI K,UCHIYAMA K,et al.Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension[J].J Hepatobiliary Pancreat Surg,2008,15(3):304-309.
    [9]BAO HK,WEI XL.Comparisons of clinical effect of hand-assisted laparoscopic and open splenectomy combined with pericardial devascularization for the treatment of portal hypertension in liver cirrhosis[J].Clin J Med Offic,2015,43(12):92-94,97.(in Chinese)包汉康,韦秀丽.手助腹腔镜与开腹脾切除贲门周围血管离断术治疗肝硬化门脉高压症的疗效比较[J].临床军医杂志,2015,43(12):92-94,97.
    [10]JANKULOVSKI N,ANTOVIC'S,PETRUEVSKA G,et al.Laparoscopic versus open splenectomy:a single center eleven-year experience[J].Acta Clinica Croatica,2013,52(2):229-234.
    [11]LYU JL,LI XP,YANG SW,et al.Laparoscopic splenectomy and pericardial devascularization for splenomegaly:a report of 15 cases[J].Chin J Mini Inv Surg,2013,13(5):406-408.(in Chinese)吕金利,李雪平,杨世伟,等.腹腔镜下巨脾切除联合贲门周围血管离断术15例[J].中国微创外科杂志,2013,13(5):406-408.
    [12]ZHENG X,DOU C,YAO Y,et al.A meta-analysis study of laparoscopic versus open splene ctomy with or without esophagogastric devascularization in the managemet of liver cirrhosis and portal hypertension[J].J Laparoendosc Adv Tech A,2015,25(2):103-111.
    [13]ZHANG Y,YANG HJ,DENG XF,et al.The effect of total laparoscopic splenectomy combined with endoscopic variceal ligation on portal hypertension in hepatitis B cirrhosis patients[J].Pract J Clin Med,2013,10(2):43-47.(in Chinese)张宇,杨洪吉,邓小凡,等.全腹腔镜脾切除联合经内镜食管曲张静脉套扎术与开腹断流术治疗门静脉高压症的临床对照研究[J].实用医院临床杂志,2013,10(2):43-47.
    [14]XU B,LIU N,XU JH.Hand-assisted laparoscopic splenectomy combined with pericardial devascularization for hepatic cirrhosis with portal hypertension[J].Chin J Gen Surg,2015,24(1):145-148.(in Chinese)许斌,刘妮,许建华.手助腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症[J].中国普通外科杂志,2015,24(1):145-148.
    [15]XU JW,ZHANG YM,SONG Y,et al.Laparoscopic splenectomy and pericardial devascularization for portal hypertension[J].Chin J Mini Inv Surg,2015,15(7):601-603.(in Chinese)徐继威,张耀明,宋越,等.完全腹腔镜下脾切除联合贲门周围血管离断术治疗门脉高压症[J].中国微创外科杂志,2015,15(7):601-603.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2072) PDF downloads(407) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return