Laparoscopic Versus Open Splenectomy and Esophagogastric Devascularization for Bleeding Varices or Severe Hypersplenism: a Comparative Study
Laparoscopic Versus Open Splenectomy and Esophagogastric Devascularization for Bleeding Varices or Severe Hypersplenism: a Comparative Study
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腹腔镜与开腹脾切除术和食管胃血管断流术治疗静脉曲张出血或严重脾功能亢进：一项比较研究
DOI：
10.1007/s11605-013-2150-4
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发表时间：
2013-04-01
影响因子：
3.2
通讯作者：
Zheng Shu-guo
中科院分区：
文献类型：
--
作者：
Cheng Zhe;Li Jian-wei;Zheng Shu-guo
腹腔镜脾切除术和食管胃断流术的安全性和可行性仍不确定。本研究的目的是将腹腔镜脾切除联合食管胃断流术与开腹脾切除联合食管胃断流术的结果进行比较。2008年1月至2011年12月，我院共确诊门静脉高压症和严重胃食管静脉曲张患者153例，其中107例患者同时出现反复上消化道出血，85例患者出现严重脾功能亢进。 80 例患者选择腹腔镜脾切除术和食管胃断流术，73 例患者接受开腹手术。回顾性比较结果和结局。腹腔镜组有9例患者中转开腹手术。我们比较了腹腔镜组（80 名患者）和开腹组（73 名患者）。手术时间和输血频率相似。腹腔镜组失血量较少（P = 0.044），排气较早（P = 0.041），住院时间较短（P = 0.028）。腹腔镜检查后门静脉系统血栓形成更常见（P = 0.012），但两组之间主干闭塞率相似。腹腔镜检查后胸腔积液较少（P = 0.021），除此之外，两组之间的其他发病率没有差异。腹腔镜组80例患者与开腹组73例患者术后2～50个月的随访期间，食管胃静脉曲张再出血、脑病和继发性肝癌的发生率无显着差异。各组死亡率无差异。腹腔镜脾切除术和食管胃断流术的短期效果优于开腹手术，两种手术方式的中期效果相似。需要进行更多病例的前瞻性随机研究来证实腹腔镜在脾切除和食管胃断流术中的作用。
The safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization are still uncertain. The aim of this study was to compare our results for laparoscopic splenectomy and esophagogastric devascularization with those for open splenectomy and esophagogastric devascularization.From January 2008 to December 2011, 153 patients were diagnosed with portal hypertension and serious gastroesophageal varices in our institute, among which, 107 patients also had repeated upper gastrointestinal bleeding and 85 had severe hypersplenism. Eighty patients chose laparoscopic splenectomy and esophagogastric devascularization and 73 patients underwent the open procedure. Results and outcomes were compared retrospectively.Nine patients underwent conversion to laparotomy in the laparoscopic group. We compared the laparoscopic group (80 patients) and the open group (73 patients). Operating times and the frequencies of blood transfusions were similar. Blood loss was less (P = 0.044), the passing of flatus was earlier (P = 0.041), and hospital stays were shorter (P = 0.028) in the laparoscopic group. Portal vein system thrombosis after laparoscopy was more frequent (P = 0.012) but the rates of main trunk occlusion were similar between the two groups. Pleural effusion after laparoscopy was less (P = 0.021) and, apart from this, there was no difference in other morbidities between the two groups. During a postoperative follow-up period of 2 to 50 months in 80 patients of the laparoscopic group vs. 73 patients of the open group, the incidence of esophagogastric variceal rebleeding, encephalopathy, and secondary liver cancer showed no significant differences. And the mortality rates for each of the groups were not different.The short-term effects of laparoscopic splenectomy and esophagogastric devascularization were better than those for open surgery, and the medium-term effects were similar between these two surgical approaches. Prospective randomized studies with a greater number of cases are needed to confirm the role of laparoscopy in splenectomy and esophagogastric devascularization.