腹腔镜联合内镜治疗门静脉高压症

摘要

目的:探讨腹腔镜脾切除贲门周围血管离断术联合内镜下食管曲张静脉套扎术(EVL)治疗门静脉高压症的可行性及疗效.方法:将105例肝硬化门静脉高压症患者分为3组,40例行内镜套扎术（套扎组）,35例行开腹脾切除贲门周围血管离断术（开腹组）,30例行腹腔镜脾切除贲门周围血管离断术联合食管曲张静脉套扎术（联合组）,分析3组术前1d及术后1,3,7d血谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)变化,比较其住院时间、术中出血、手术时间、术后肛门排气时间及奇静脉内径、血流速度及血流量、食管静脉曲张复发、再出血率等相关资料.结果:联合组与开腹组术后第1天TBIL,DBIL比较差异有统计学意义(P＜0.05),第7天AST比较差异有统计学意义(P＜0.05),2组住院时间、术中出血、手术时间、术后肛门排气时间差异有统计学意义(P＜0.05)；联合组、开腹组及套扎组在治疗前后奇静脉血流量及食管静脉曲张复发、再发出血比较差异无统计学意义(P＜0.05).结论:腹腔镜断流联合食管静脉套扎治疗门静脉高压症,具有创伤小、恢复快、并发症少、复发率低、能减少奇静脉血流量等优点,疗效确切.%Objective To determine the therapeutic effect of laparoscopic splenectomy, perisoph-agogastric devascularization, and endoscopic variceal ligation (EVL) on patients with portal hypertension. Methods We randomly divided 105 patients into 3 groups; 40 had endoscopic band ligation (the ligation group), 35 had splenectomy and perisoph-agogastric devascularization (the laparotomy group) , and the other 30 had laparoscopic splenectomy, perisoph-agogastric devascularization and endoscopic variceal ligation (the combination group). Blood samples were analyzed preoperatively and postoperatively on day 1,3,and 7,including alanine aminotransferase(ALT) ,as-partate aminotransferase (AST), total bilirubin(TBIL) ,and directed bilirubin(DBIL). The length of stay, blood loss, operation time, anal exhaust time, azygos vein diameter, blood flow velocity and blood flow, recurrence of esophageal varices and rehaemorrhagia were compared. Results Between the combination group and the laparotomy group, the serum levels of TbIL and Dbil had difference on 1 st postoperative day(P<0.05). AST had difference on 7th postoperative day (P < 0.05). The length of stay, blood loss, operation time, and anal exhaust time had significant difference(P < 0.05). Among the combination group, the laparotomy group and the ligation group, the azygos vein blood flow before and after the treatment, recurrence of esophageal varices and rehaemorrhagia hadno difference(P<0.05). Conclusion Laparoscopic splenectomy, perisoph-agogastric devascular-ization and endoscopic variceal ligation have less trauma, lower recurrence rate, fewer complications and rapid recovery, and may reduce the azygous vein blood flow. It can be used safely for portal hypertension.