完全腹腔镜与开腹行脾切除门奇静脉断流术治疗门静脉高压的临床对比研究

发布时间：2018-02-07 10:50

  本文关键词： 腹腔镜脾切除 肝硬化 门静脉高压 门奇静脉断流术　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:在腹腔镜技术辅助下,采用全新的手术方案治疗肝硬化门脉高压症导致的食管下段、胃底血管曲张、脾肿大、脾功能亢进,对比开腹下行门奇静脉断流术传统方案的疗效,揭示出新方案在安全性、可行性方面的表现。方法收集2002-2016年我院普外科行门奇静脉断流术治疗门脉高压患者35例。将患者分为两组:其中,腹腔镜组15例患者接受完全腹腔镜下行门奇静脉断流术联合脾切除术治疗;传统开腹组20例行开腹门奇静脉断流术联合脾切除,从平均住院时间、手术时间、术中出血量、手术费用、拔管时间、术后2天引流管引流量及排气间隔的时间变化,血液学、生化检查方面比较二者的术后72小时的肝功能、白蛋白、血糖、血小板、白细胞以及血红蛋白等指标的变化情况。结果两种手术方式在费用、血红蛋白以及血小板变化方面不具有显著性差异(p0.05);平均住院时间、术中出血量、拔管时间、术后2天引流管引流量及排气时间均优于开腹组(p0.05);围手术期谷丙转氨酶、总胆红素、白蛋白、血糖值以及白细胞变化腹腔镜组均小于开腹组(p0.05);手术时间上开腹组优于腹腔镜组(p0.05)结论:完全腹腔镜下行门奇静脉断流术联合脾切除术与传统开腹下行门奇静脉断流术联合脾切除手术相比更具有优势。
[Abstract]:Objective: to treat lower esophagus, gastric fundus vascular varices, splenomegaly, hypersplenism and hypersplenism in patients with cirrhotic portal hypertension. By comparing the efficacy of the traditional method of portal azygous vein devascularization under laparotomy, the safety of the new protocol was revealed. Methods from 2002 to 2016, 35 patients with portal hypertension were treated with portal azygous vein devascularization. The patients were divided into two groups:. 15 patients in the laparoscopic group were treated with complete laparoscopic portal azygous vein devascularization combined with splenectomy, and 20 patients in the traditional laparotomy group were treated with open portal azygous vein devascularization combined with splenectomy. The operation cost, extubation time, drainage flow rate and the time change of exhaust interval, hematology and biochemical examination were compared between the two groups in liver function, albumin, blood glucose, platelets. Results there was no significant difference in cost, hemoglobin and platelet changes between the two types of operation, mean hospitalization time, blood loss during operation, extubation time, etc. 2 days after operation, the drainage flow and exhaust time of the drainage tube were better than that of the open group (P 0.05), and the levels of alanine aminotransferase, total bilirubin and albumin in the perioperative period were higher than those in the open group. The blood glucose and leukocyte changes in laparoscopic group were lower than those in laparotomy group (P 0.05), and the operative time in laparotomy group was better than that in laparoscopy group (P 0.05). Conclusion: complete laparoscopic surgery combined with splenectomy and traditional laparoscopic operation of portal azygous vein is better than that of laparoscopy group (P 0.05). Devascularization combined with splenectomy has more advantages than splenectomy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.34
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本文编号：1494200