摘要
目的探析肝硬化所致脾功能亢进中运用腹腔镜脾脏切除术(LS)与开腹脾脏切除术(OS)的临床疗效。方法从江门市中心医院肝胆外科自2016年1月~2018年12月收治的肝硬化所致脾功能亢进患者中抽取100例作为研究对象,采取随机数字表法分为两组:以单号50例行开腹脾脏切除术的对照组及以双号50例行腹腔镜脾脏切除术的观察组。比较两组肝硬化所致脾功能亢进患者的手术相关参数、肝功能状况、炎症反应及术后并发症情况。结果观察组手术时间高于对照组,差异有统计学意义(P <0.05);观察组术后拔管时间和住院时间短于对照组,差异有统计学意义(P <0.05);观察组术中出血量少于对照组,差异有统计学意义(P <0.05);两组治疗前ALT、AST、Tbil、Dbil指标水平比较,差异无统计学意义(P> 0.05);两组经治疗1d后ALT、AST、Tbil、Dbil指标水平均高于治疗前,差异有统计学意义(P <0.05),且行腹腔镜脾脏切除术的观察组上升幅度低于对照组,差异有统计学意义(P <0.05);两组经治疗1周后,ALT、AST、Tbil、Dbil指标水平均高与治疗前,差异有统计学意义(P <0.05),观察组中ALT、AST、Dbil指标水平上升幅度低于对照组,差异有统计学意义(P <0.05)。两组治疗前CRP及WBC指标水平比较,差异无统计学意义(P> 0.05),两组治疗1d及3d后CRP及WBC指标水平高于治疗前,差异有统计学意义(P <0.05);且行腹腔镜脾脏切除术的观察组治疗1d及3d后CRP及WBC指标水平均低于对照组,差异有统计学意义(P <0.05)。观察组并发症发生率为4%,低于对照组的26%,差异有统计学意义(P <0.05)。结论经腹腔镜脾脏切除术治疗肝硬化所致脾功能亢进,较之开腹脾脏切除术而言,手术时间略微长,但切口痛楚更轻,拔管及住院时间更短,且肝功能状况有明显改善,炎症反应大为减轻,降低了术后并发症发生。
Objective To explore the clinical effect of laparoscopic splenectomy(LS)and open splenectomy(OS)in hypersplenism caused by liver cirrhosis. Methods 100 patients with hypersplenism caused by liver cirrhosis treated in hepatobiliary surgery of Jiangmen Central Hospital from January 2016 to December 2018 were selected as subjects, and divided into two groups using the random number table method:the control group(n=50,with the odd number and OS)and the observation group(n=50,with even number and LS).The operation related parameters,liver function,inflammatory reaction and postoperative complications were compared between the two groups. Results The operation time of the observation group was higher than that of the control group,and the difference was statistically significant(P < 0.05);the extubation time and hospitalization time of the observation group were shorter than those of the control group,and the differences were statistically significant(P < 0.05);the amount of bleeding in the observation group was less than that of the control group, and the difference was statistically significant(P < 0.05);before treatment,the differences of alanine aminotransferase(ALT),aspartic transaminase(AST),total bilirubin(Tbil)and direct bilirubin(Dbil)indexes between the two groups were not statistically significant(P > 0.05);after one day of treatment,the levels of ALT,AST,Tbil and Dbil in the two groups were higher than those before treatment,and the differences were statistically significant(P < 0.05),and the rising range of laparoscopic splenectomy in the observation group was lower than that in the control group,with statistical significance(P < 0.05);after one week of treatment,the levels of ALT,AST,Tbil and Dbil in the two groups were higher than those before treatment,and the differences were statistically significant(P < 0.05),and the increase of above index in the observation group was significantly lower than that in the control group(P < 0.05).There was no significant difference in the levels of CRP and WBC between the two groups before treatment(P > 0.05),the levels of c reactive protein(CRP)and white blood cell(WBC)at 1 and 3 days after treatment in the two groups were higher than those before treatment(P < 0.05);the levels of CRP and WBC at 1 and 3 days after treatment in the observation group were lower than those in the control group(P < 0.05).The incidence of complications in the observation group was 4%,which was lower than that in the control group(26%)(P < 0.05). Conclusion Compared with OS,LS has a slightly longer operation time,but less incision pain,shorter extubation and hospitalization time,significantly improves liver function,greatly reduces inflammatory response and postoperative complications.
作者
陈浚江
谭慧敏
余杰雄
CHEN Junjiang;TAN Huimin;YU Jiexiong(Hepatobiliary Surgery,Jiangmen Central Hospital,Guangdong,Jiangmen 529030,China)
出处
《中国医药科学》
2020年第4期222-225,268,共5页
China Medicine And Pharmacy
