腹腔镜脾动脉结扎联合贲门周围血管离断术治疗肝硬化门静脉高压症的回顾性研究

Retrospective study of laparoscopic splenic artery ligation combined with pericardial devascularization for portal hypertension in cirrhosis

摘要:

目的 探讨腹腔镜脾动脉结扎（SAL）联合贲门周围血管离断术（EED）治疗肝硬化门静脉高压症（PHT）的治疗效果。方法 回顾性研究2020年7月至2023年5月安阳市第三人民医院和安阳市第五人民医院收治的126例肝硬化PHT患者资料，根据不同手术方式分为观察组（69例，行腹腔镜SAL术联合EED）和对照组［57例，行腹腔镜脾切除术（LS）联合EED］。比较两组患者围术期指标；比较术前及术后14 d血常规指标［血小板计数（PLT）、白细胞计数（WBC）、红细胞计数（RBC）］、肝功能指标［丙谷转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（GGT）］、凝血功能指标［活化部分凝血酶时间（APTT）、纤维蛋白原（FIB）、凝血原酶时间（PT）］，观察两组患者术后并发症发生情况。结果 观察组各项围术期指标均低于对照组（P<0.05）；术后14 d，观察组PLT、WBC水平低于对照组（P<0.05），且RBC水平与对照组比较差异无统计学意义（P>0.05）；观察组ALT、AST、GGT、APTT、PT水平低于对照组，FIB高于对照组（P<0.05）；观察组术后并发症总发生率低于对照组（P<0.05）。结论 腹腔镜SAL联合EED能提高治疗肝硬化PHT的手术效果，改善患者脾功能亢进，改善肝功能及凝血功能，降低并发症的发生。

Abstract:

Objective To investigate the therapeutic effect of laparoscopic splenic artery ligation (SAL) combined with pericardial devascularization (EED) in the treatment of liver cirrhosis portal hypertension (PHT).Methods Clinical data of 126 cirrhotic PHT patients admitted to Anyang Third People's Hospital and Anyang Fifth People's Hospital from July 2020 to May 2023 were retrospectivly studied, and the patients were divided into observation group (69 cases, laparoscopic SAL combined with EED) and control group [57 cases, laparoscopic splenectomy (LS) combined with EED]. Perioperative indicators were compared between the two groups: preoperative and postoperative 14-day blood routine indexes [platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC)], liver function index [transglutamase (ALT), glutamicum transaminase (AST), γ-glutamyl transpeptidase (GGT)], coagulation index [activated partial thromboplastin time (APTT), fibrinogen (FIB), prothrombin time (PT)], and the occurrence of postoperative complications was observed.Results All perioperative indicators of the observation group were lower than those of the control group (P<0.05). Fourteen days after surgery, PLT and WBC levels of the observation group were lower than those of the control group (P<0.05), and there was no statistical difference in RBC level between the two groups (P>0.05). In the observation group, ALT, AST, GGT, APTT, and PT were lower, and FIB was higher than those in the control group (P<0.05). The overall incidence of postoperative complications of the observation group was lower than that of the control group (P<0.05).Conclusion Laparoscopic SAL combined with EED can improve the surgical effect of PHT, improve hypersplenism, improve liver function and coagulation function, and reduce the occurrence of complications.