目的：探讨肝硬化门脉高压症继发脾功能亢进、胃底静脉曲张患者行手助腹腔镜与开腹贲门周围血管离断、脾脏切除术的肝功能变化及临床疗效。方法回顾性分析2010年1月-2013年1月施行脾脏切除、贲门周围血管离断术治疗肝硬化门静脉高压症72例，其中手助腹腔镜手术组29例、开腹手术43例。术前按Child法进行肝功能分级，对比分析两组手术时间、术中失血量、术后并发症发生率、肝功能损害和死亡率。结果手助腹腔镜组与开腹组术中并发症发生率差异无统计学意义(P>0.05)；开腹组ALT、AST术后均比术前显著升高，差异均有统计学意义(P<0.05)，手助腹腔镜组ALT、AST术后均较术前升高，其中AST升高有统计学意义(P<0.05)。结论手助腹腔镜脾脏切除加贲门周围血管离断术对肝功能影响较开腹组小，术后并发症少，是相对安全可行的。%Objective To discuss the change of liver function in the patients after hand-assisted laparoscopic or open splenectomy combined with extensive devascularization around the cardia for treating secondary hypersplenism gastric varices due to cirrhotic portal hypertension and the treatment effect. Methods Retrospective analysis on 72 patients with cirrhotic portal hypertension who underwent splenectomy combined with extensive devascularization around the cardia in our hospital between January 2010 and January 2013 was carried out. There were 29 patients in the hand-assisted laparoscopic group and 43 in the open group. Child-pugh classification of liver function was undertaken preoperatively, and the operation duration, intraoperative blood loss, postopera-tive complication rate and mortality was comparative analyzed between the two groups. Results There was no statistically signifi-cant difference between the two groups in intraoperative complications, P>0.05; ALT and AST were higher after treatment than be-fore in the open group, and the differences were statistically significant, P<0.05, while in the hand-assisted laparoscopic group, the ALT was higher after treatment than before without statistical difference, and the AST was higher after treatment than before with statistical difference, P<0.05. Conclusion Compared with open model, hand-assisted laparoscopic splenectomy combined with ex-tensive devascularization around the cardia has less affect on liver function and less complication, and is safe and feasible.
展开▼
