腹腔镜脾切除联合断流术中保留迷走神经在肝硬化门静脉高压患者中的应用

摘要
图/表
参考文献(18)
相关文章 (15)

全文: PDF (0 KB) HTML (37 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探究腹腔镜脾切除联合断流术中保留迷走神经在肝硬化门静脉高压患者中的应用效果。方法选取2015年3月～2020年1月于湖北省监利市第五人民医院就诊的74 例肝硬化门静脉高压患者作为研究对象，按照随机数字表法分为对照组（n=37，采用腹腔镜脾切除联合断流术治疗）和观察组（n=37，在对照组治疗基础上保留迷走神经）。比较两组患者手术相关指标（手术时间、术中出血量、术后自由门静脉压、术后胃液引流量、住院时间），比较术前及术后3 个月时两组生活质量[反流、消化不良生存质量量表（QOLRAD）评分]，比较术后7 d 内两组并发症（餐后腹胀、腹泻、胃潴留、门静脉血栓）发生率。结果观察组患者手术时间短于对照组，差异有统计学意义（P<0.05）；观察组患者术中出血量、术后胃液引流量均少于对照组，差异有统计学意义（P<0.05）；两组患者术后自由门静脉压、住院时间比较，差异无统计学意义（P>0.05）。术后3 个月时，观察组患者的QOLRAD 评分与同组术前比较，差异无统计学意义（P>0.05）；对照组患者术后3 个月时的QOLRAD 评分低于同组术前，差异有统计学意义（P<0.05）；观察组患者术后3 个月时的QOLRAD 评分高于对照组，差异有统计学意义（P<0.05）。术后7 d 内，观察组患者餐后腹胀、腹泻、胃潴留生率均低于对照组，差异有统计学意义（P<0.05）；两组患者门静脉血栓发生率比较，差异无统计学意义（P>0.05）。结论腹腔镜脾切除联合断流术中保留迷走神经治疗肝硬化门静脉高压患者手术操作更便捷，且可有效维护患者胃功能，改善患者生存质量，减少相关并发症发生。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	罗剑
	何文法

关键词 ：腹腔镜脾切除, 断流术, 保留迷走神经, 肝硬化门静脉高压, 胃功能, 生存质量

Abstract：Objective To explore the application effect of laparoscopic splenectomy combined with vagus nerve preservation during devascularization in patients with cirrhotic portal hypertension.Methods A total of 74 patients with cirrhotic portal hypertension treated in Jianli Fifth People′s Hospital,Hubei Province from March 2015 to January 2020 were selected as the research objects,and they were divided into control group(n=37,treated with laparoscopic splenectomy combined with devascularization)and observation group(n=37,given vagus nerve preservation on the basis of control group)according to the random number table method.The related surgical indicators(surgical time,intraoperative blood loss,postoperative free portal vein pressure,postoperative gastric juice drainage volume and hospital stay)were compared between the two groups,the quality of life(quality of life in reflux and dyspepsia questionnaire[QOLRAD]score)was compared between the two groups before surgery and at 3 months after surgery,and the incidence rates of complications(postprandial abdominal distension,diarrhea,gastric retention and portal vein thrombosis)were compared between the two groups within 7 d after surgery.Results The surgical time of the observation group was shorter than that of the control group,the difference was statistically significant(P<0.05).The intraoperative blood loss and postoperative gastric juice drainage volume in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the postoperative free portal vein pressure and hospital stay between the two groups(P>0.05).At 3 months after surgery,there was no significant difference in QOLRAD score in the observation group compared with that before surgery(P>0.05).The QOLRAD score at 3 months after surgery in the control group was lower than that of the same group before surgery,the difference was statistically significant(P<0.05).The QOLRAD score at 3 months after surgery in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).Within 7 d after surgery,the incidence rates of postprandial abdominal distension,diarrhea and gastric retention in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence rate of portal vein thrombosis between the two groups(P>0.05).Conclusion Laparoscopic splenectomy combined with vagus nerve preservation during devascularization has more convenient operation in the treatment of patients with cirrhotic portal hypertension,and it can effectively maintain the gastric function,improve the quality of life,and reduce the occurrence of related complications of patients.

Key words： Laparoscopic splenectomy Devascularization Vagus nerve preservation Cirrhotic portal hypertension Gastric function Quality of life

作者简介: 罗剑（1978-），男，汉族，湖北监利人，主治医师，研究方向：普外科

引用本文:

罗剑;何文法. 腹腔镜脾切除联合断流术中保留迷走神经在肝硬化门静脉高压患者中的应用[J]. 中国当代医药, 2021, 28(18): 63-66.
LUO Jian; HE Wen-fa. Application of laparoscopic splenectomy combined with vagus nerve preservation during devascularization in patients with cirrhotic portal hypertension. 中国当代医药, 2021, 28(18): 63-66.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I18/63

[1]	徐伟，涂兵.断流术在肝硬化门静脉高压中的作用及争议[J].临床肝胆病杂志，2020，36（3）：670-672.
[2]	蒋国庆，柏斗胜，陈平，等.保留迷走神经的腹腔镜脾切除联合断流术治疗门静脉高压症的疗效评价[J].中华普通外科杂志，2018，33（7）：548-551.
[3]	中华医学会肝病学分会，中华医学会消化病学分会，中华医学会消化内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].中华内科杂志，2016，55（1）：57-72.
[4]	官小莉，汪晖.胃食管反流病患者生存质量测评量表的研究进展[J].中华护理杂志，2015，50（1）：97-101.
[5]	孙伟峰，梁品.迷走神经腹腔支在功能保留性胃切除术中的意义[J].中华胃肠外科杂志，2020，23（10）：935-938.
[6]	刘德连，张学伟，吕方启.胃癌术后胃瘫发生的影响因素分析[J].中华肿瘤杂志，2017，39（2）：150-153.
[7]	郑智，张海翘，尹杰，等.食管裂孔疝术中迷走神经保护的必要性及解剖学探讨[J].国际外科学杂志，2020，47（4）：277-280.
[8]	夏明杰，王权.保留贲门的胃节段切除术在早期胃癌手术中的应用[J].中华胃肠外科杂志，2020，23（10）：931-934.
[9]	冯彩华，连娟，付朝霞.3D 腹腔镜辅助保留迷走神经远端根治术治疗胃癌的疗效及近期生活质量评价[J].中华普外科手术学杂志（电子版），2019，13（3）：290-293.
[10]	季锋，汪忠镐，韩新巍，等.胃食管反流致血管迷走神经性晕厥和慢性支气管炎一例[J].中华普通外科杂志，2020，35（8）：611.
[11]	燕速，马新福，赵康，等.早期胃上部癌腹腔镜近端胃切除术实践与思考[J].中华腔镜外科杂志（电子版），2020，13（3）：141-145.
[12]	李昊楠，王静，郑晶晶，等.腹腔镜胆囊切除术中切断迷走神经肝支对胆囊结石患者胆心反射及血清氧化还原酶水平的影响[J].医学临床研究，2019，36（4）：732-734.
[13]	谭伟超.腹腔镜高选择性迷走神经离断术对上消化道溃疡穿孔的治疗效果观察[J].中国实用神经疾病杂志，2017，20（4）：95-96.
[14]	张楠楠，邓靖宇.从术后生活质量看保留迷走神经远端胃癌根治术在早期胃癌治疗中的应用[J].中华胃肠外科杂志，2017，20（9）：1085-1086.
[15]	田明国.肝硬化门静脉高压症外科治疗的优势及挑战[J].肝胆胰外科杂志，2020，32（10）：577-580，594.
[16]	尹昕茹，陈东风.肝硬化的胃肠道并发症[J].中华肝脏病杂志，2020，28（5）：377-380.
[17]	庄壁龙.保留迷走神经-幽门的胃癌根治术在早期胃癌治疗中的应用[J].黑龙江医药，2018，31（2）：368-369.
[18]	张驰，胡祥.从日本胃癌研究看早期胃癌保留功能胃切除术[J].中华胃肠外科杂志，2018，21（2）：148-153.