脾切除联合贲门周围血管离断术对肝硬化导致消化道出血的效果观察(1)
[摘要] 目的 比较腹腔镜下脾切除联合贲门周围血管离断术与开腹手术治疗肝硬化导致消化道出血的临床效果。 方法 选取2010年1月～2014年1月我院收治的的肝硬化导致的消化道出血患者70例，根据手术方案的不同将入选者分为研究组与对照组。研究组给予腹腔镜下脾切除联合贲门周围血管离断术，对照组给予开腹脾切除联合贲门周围血管离断术。观察两组患者的一般手术情况、手术前后的免疫球蛋白M(IgM)及C反应蛋白(CRP)水平、术后并发症发生情况等。 结果 研究组患者的手术时间、术中出血量、术后排气时间、术后进食时间、术后拔管时间、术后住院时间分别为(164.3±44.2)min、(298.2±28.5)ml、(2.1±0.8)d、(2.2±1.1)d、(4.1±1.3)d、(8.9±2.8)d，对照组分别为(214.3±51.9)min、(423.6±32.9)ml、(3.8±1.4)d、(4.0±1.3)d、(7.4±2.9)d、(14.5±4.8)d，两组差异有统计学意义(P<0.05)；两组患者手术前的IgM、CRP水平差异无统计学意义(P>0.05)，手术后，研究组的IgM、CRP水平分别为(1.41±0.18)g/L、(20.78±13.45)mg/L，对照组分别为(0.85±0.09)g/L、(46.56±25.65)mg/L，两组差异有统计学意义(P<0.05)；两组的术后并发症发生率差异无统计学意义(P>0.05)。 结论 腹腔镜下脾切除联合贲门周围血管离断术治疗硬化导致消化道出血，对患者的损伤较小，患者术后恢复快，对机体免疫功能的影响较小，且并发症发生率低，值得推广。
[关键词] 脾切除联合贲门周围血管离断术；肝硬化；消化道出血；腹腔镜；开腹手术
[中图分类号] R575.2+9 [文献标识码] A [文章编号] 1674-4721(2016)02(a)-0026-03
Effects observation of splenectomy combined with peripheral cardia devascularization in treatment of gastrointestinal hemorrhage caused by liver cirrhosis
YANG Lin1 PAN Ji-yong1▲ JIN Rong2
The First Department of General Surgery，the Third People′s Hospital of Dalian City，Dalian 116033，China；2.The Second Department of Gastroenterology，the First Hospital Affiliated to Dalian Medical University，Dalian 116027，China
[Abstract] Objective To compare the clinical effect of laparoscopic splenectomy combined with peripheral cardia devascularization and open surgery in treatment of gastrointestinal hemorrhage caused by liver cirrhosis. Methods 70 patients with gastrointestinal hemorrhage caused by liver cirrhosis received by our hospital from January 2010 to January 2014 were selected and divided into the study group and the control group according to their operation patterns.Study group was treated by laparoscopic splenectomy combined with peripheral cardia devascularization，while control group was treated by open-surgery splenectomy combined with peripheral cardia devascularization.The general operation condition，IgM and CRP level before and after operation，and incidence of postoperative complications in two groups was observed respectively. Results The operation time，blood loss during operation，evacuation time after operation，feeding time after operation，extubation time after operation， and hospitalization time after operation of patients in study group was (164.3±44.2) min，(298.2±28.5) ml，(2.1±0.8) d，(2.2±1.1) d，(4.1±1.3) d，and (8.9±2.8) d respectively，and it in the control group was (214.3±51.9) min，(423.6±32.9) ml，(3.8±1.4) d，(4.0±1.3) d，(7.4±2.9) d，and (14.5±4.8) d respectively and there was a statistical difference between two groups (P<0.05).The IgM and CRP level of patients in both groups showed no significant difference before operation (P>0.05).After operation，the IgM and CRP level of patients in study group was (1.41±0.18) g/L and (20.78±13.45) mg/L，while it in the control group was (0.85±0.09) g/L and (46.56±25.65) mg/L，and there was a statistical difference between two groups (P<0.05).As to the incidence rate of postoperative complication，there was no statistical difference between two groups (P>0.05). Conclusion Laparoscopic splenectomy combined with peripheral cardia devascularization has minor damage to patients in treatment of gastrointestinal hemorrhage caused by liver cirrhosis with rapid postoperative recovery and minor influence on immune function，as well as lower incidence rate of complication，and it is worthy of promotion., 百拇医药(杨琳 潘吉勇 金荣)
[关键词] 脾切除联合贲门周围血管离断术；肝硬化；消化道出血；腹腔镜；开腹手术
[中图分类号] R575.2+9 [文献标识码] A [文章编号] 1674-4721(2016)02(a)-0026-03
Effects observation of splenectomy combined with peripheral cardia devascularization in treatment of gastrointestinal hemorrhage caused by liver cirrhosis
YANG Lin1 PAN Ji-yong1▲ JIN Rong2
The First Department of General Surgery，the Third People′s Hospital of Dalian City，Dalian 116033，China；2.The Second Department of Gastroenterology，the First Hospital Affiliated to Dalian Medical University，Dalian 116027，China
[Abstract] Objective To compare the clinical effect of laparoscopic splenectomy combined with peripheral cardia devascularization and open surgery in treatment of gastrointestinal hemorrhage caused by liver cirrhosis. Methods 70 patients with gastrointestinal hemorrhage caused by liver cirrhosis received by our hospital from January 2010 to January 2014 were selected and divided into the study group and the control group according to their operation patterns.Study group was treated by laparoscopic splenectomy combined with peripheral cardia devascularization，while control group was treated by open-surgery splenectomy combined with peripheral cardia devascularization.The general operation condition，IgM and CRP level before and after operation，and incidence of postoperative complications in two groups was observed respectively. Results The operation time，blood loss during operation，evacuation time after operation，feeding time after operation，extubation time after operation， and hospitalization time after operation of patients in study group was (164.3±44.2) min，(298.2±28.5) ml，(2.1±0.8) d，(2.2±1.1) d，(4.1±1.3) d，and (8.9±2.8) d respectively，and it in the control group was (214.3±51.9) min，(423.6±32.9) ml，(3.8±1.4) d，(4.0±1.3) d，(7.4±2.9) d，and (14.5±4.8) d respectively and there was a statistical difference between two groups (P<0.05).The IgM and CRP level of patients in both groups showed no significant difference before operation (P>0.05).After operation，the IgM and CRP level of patients in study group was (1.41±0.18) g/L and (20.78±13.45) mg/L，while it in the control group was (0.85±0.09) g/L and (46.56±25.65) mg/L，and there was a statistical difference between two groups (P<0.05).As to the incidence rate of postoperative complication，there was no statistical difference between two groups (P>0.05). Conclusion Laparoscopic splenectomy combined with peripheral cardia devascularization has minor damage to patients in treatment of gastrointestinal hemorrhage caused by liver cirrhosis with rapid postoperative recovery and minor influence on immune function，as well as lower incidence rate of complication，and it is worthy of promotion., 百拇医药(杨琳 潘吉勇 金荣)