腹腔镜与开腹脾切除术治疗肝硬化门静脉高压症患者的临床效果比较

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摘要目的探讨并比较腹腔镜与开腹脾切除术治疗肝硬化门静脉高压症患者的临床效果。方法选取2016年1月～2018年3月在我院进行诊治的72 例肝硬化门静脉高压症患者作为研究对象，运用随机数字表法将其分为观察组与对照组，每组各36 例。对照组患者采用开腹脾切除术，观察组患者采用腹腔镜脾切除术。比较两组患者的住院指标、肝功能指标、白细胞、血小板水平及疗效。结果观察组患者的手术时间长于对照组，术中出血量少于对照组，切口疼痛视觉模拟量表（VAS）评分低于对照组，术后下床时间、术后住院时间短于对照组，差异有统计学意义（P＜0.05）。术后第1、7 天，观察组患者的血清丙氨酸氨基转移酶（ALT）、血清天门冬氨酸氨基转移酶（AST）、血清总胆红素（TBil）、血清直接胆红素（DBil）均低于对照组，差异有统计学意义（P＜0.05）。观察组患者术后1 个月的白细胞、血小板水平高于对照组，差异有统计学意义（P＜0.05）。观察组患者的治疗总有效率为94.44%，高于对照组的77.78%，差异有统计学意义（P＜0.05）。结论腹腔镜脾切除术能够缓解患者的手术疼痛，减轻对肝功能的影响，保护患者免疫功能，值得应用推广。

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	曾伟

关键词 ：腹腔镜脾切除术, 开腹脾切除术, 肝硬化门静脉高压症, 治疗效果, 肝功能

Abstract：Objective To investigate and compare the clinical effect between laparoscopic and open splenectomy in the treatment of patients with cirrhotic portal hypertension. Methods A total of 72 patients with cirrhotic portal hypertension who were diagnosed and treated in our hospital from January 2016 to March 2018 were selected as subjects, and divided into the observation group and the control group by the random number table method, with 36 cases in each group. The control group was treated with open splenectomy, while the observation group was treated with laparoscopic splenectomy. The hospitalization indexes, liver function indexes, white blood cells, platelet and curative effect were compared between the two groups. Results The operation time of the observation group was longer than that of the control group, the intraoperative blood loss was less than that of the control group, the visual analogue scale (VAS) score of incision pain was lower than that of the control group, the postoperative time to get up of bed and postoperative hospital stay were shorter than those in the control group, the differences were statistically significant (P＜0.05). On the 1st and 7th day after the operation, the serum alanine aminotransferase (ALT), serum aspartic aminotransferase (AST), serum total bilirubin (TBil) and serum direct bilirubin (DBil) in the observation group were all lower than those in the control group, with statistically significant differences (P＜0.05). The leucocyte and platelet levels in the observation group were higher than those in the control group one month after the operation, with statistically significant differences (P＜0.05).The total effective rate of the observation group was 94.44%, which was higher than that of the control group (77.78%),and the difference was statistically significant (P＜0.05). Conclusion Laparoscopic splenectomy can relieve the pain caused by surgery, reduce the impact on liver function, and protect the immune function of patients.

Key words： Laparoscopic splenectomy Open splenectomy Cirrhotic portal hypertension Curative effect Liver function

作者简介: 曾伟（1977-），男，汉族，江西抚州人，硕士，主治医师，研究方向：普外科

引用本文:

曾伟. 腹腔镜与开腹脾切除术治疗肝硬化门静脉高压症患者的临床效果比较[J]. 中国当代医药, 2020, 27(7): 102-105.
ZENG Wei. Clinical effect comparison between laparoscopic and open splenectomy in the treatment of patients with cirrhotic portal hypertension. 中国当代医药, 2020, 27(7): 102-105.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I7/102

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