摘要
目的探讨序贯的腹腔镜脾切除加断流术联合术后内镜套扎术治疗肝硬化门静脉高压症上消化道出血的安全性及疗效。方法回顾性分析2012年2月至2016年3月扬州大学临床医学院肝胆外科收治的219例肝硬化性门静脉高压症伴食管静脉曲张破裂出血和脾功能亢进患者的临床资料，其中行腹腔镜脾切除加断流术联合术后定期内镜套扎术的为序贯组（114例），行腹腔镜脾切除加断流术未联合术后内镜套扎术的为非序贯组（105例）。结果序贯组的术后1年内总出血率和4个月后的出血率均低于非序贯组（3．5％比17．1％和0．9％比14．7％），差异均有统计学意义（X2=11．243、14．581，均P〈0．01）。术后3、6、9个月，序贯组的食管曲张静脉内径分别为（7．4±3．2）、（4．1±2．2）、（3．4±1．2）cm，差异均有统计学意义，均P〈0．05；内镜的套扎率分别为58．8％、12．7％、3．4％，差异均有统计学意义，均P〈0．01。12个月后的套扎率为0。结论序贯的腹腔镜脾切除加断流术联合术后内镜套扎治疗门静脉高压症上消化道出血是安全可行的，有效地降低了患者术后的再出血率。
Objective To investigate the clinical safety and value of sequential therapy combining laparoscopic splenectomy and azygoportal disconnection with postoperative endoscopic variceal ligation （EVL） for portal hypertensive variceal bleeding. Methods From February 2012 to March 2016, 114 patients underwent sequential laparoscopic splenectomy plus azygoportal disconnection and periodical postoperative endoscopic variceal ligation. Results were compared with those who underwent laparoscopic splenectomy and azygoportal disconnection without postoperative endoscopic variceal ligation in a group of 105 cases. Results Between the two groups oesophageal variceal re-bleeding （EVR） rates during first postoperative 3 months was not significantly different （ P 〉 0. 05 ）, however, sequential therapy group was associated with lower EVR rates during the periods ranging from 1 to 12 months, and 4 to 12 months compared with non-sequential therapy group （ all P 〈 0.05 ） . Dynamic changes in the diameter of oesophageal varices and EVL rates in sequential therapy group both decreased gradually and significandy over the 12-month follow-up period （all P 〈0. 01 ）. No one in sequential therapy group suffered EVR from 6th month onward. No patient required EVL at the 12th month in sequential therapy group. Conclusion Sequential laparoscopic splenectomy plus azygoportal disconnection and postoperative EVL for portal hypertensive variceal bleeding is safe, feasible and effective in decreasing postoperative EVR rates.
作者
蒋国庆
柏斗胜
陈平
钱建军
金圣杰
高志慧
张弛
Jiang Guoqing, Bai Dousheng, Chen Ping, Qian Jianjun, Jin Shengjie, Gao Zhihui, Zhang Chi(Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, Yangzhou 225001, China)
出处
《中华普通外科杂志》
CSCD
北大核心
2018年第9期747-750,共4页
Chinese Journal of General Surgery
基金
江苏省青年医学人才资助项目（QNRC2016331）
江苏省卫生计生委面上科研资助项目（H201661）
