腹腔镜论文手助腹腔镜脾切除门奇静脉断流术与开腹手术的临床对比研究.docVIP

腹腔镜论文：手助腹腔镜脾切除门奇静脉断流术与开腹手术的临床对比研究 【中文摘要】通过与开腹脾切除门奇静脉断流术对比,探讨手助腹腔镜脾切除加门奇静脉断流术的临床应用前景和推广价值。方法：2008年1月至2009年6月,一个治疗小组对我院29例肝硬化并门静脉高压病人行手助腹腔镜脾切除加门奇静脉断流术,与同期29例门静脉高压病人行开腹手术进行对比分析。比较两组的手术时间、术中出血量、术后发热时间、术后排气时间、术后切口疼痛时间、术后住院时间,术后并发症,术后肝功能变化,术后再出血率等有无差异。结果：①围手术期临床指标比较结果：29例手助腹腔镜脾切除加门奇静脉断流术获得成功。腹腔镜组手术时间为 143±42 min,开腹组为 211±47 min,腹腔镜组手术时间比开腹组短 P0.05 。③术后一年再出血率比较结果：腹腔镜组是3.4% 1例 ,开腹组是6.8% 2例 ,两组比较差异无统计学意义 P 0.05 。④肝功能比较结果：腹腔镜组术后第3天血总胆红素为 17.6±8.6 μmmol/L,开腹组术后第3天血总胆红素为 24.1±10.3 μmmol/L,腹腔镜组术后第3天血总胆红素比开腹组低 P0.05 。手助腹腔镜脾切除加门奇静脉断流术是安全可行的,且比开腹手术具有微创性。 【英文摘要】:To evaluate the clinical application value of the hand assistant laparoscopic splenectomy plus Porta-agygous devascularization by comparing with the open procedure.Methods:From January 2008 to June 2009,29 patients with portal hypertension were treated by hand assistant laparoscopic splenectomy plus porta-agygous devascularization,29 patients were treated by laparotomy on the same term. The purpose was to compare the two groups?clinical outcomes of the operative time、hemorrhage volume、fever time、the time of recover pass gas、pain time、hospital stay、the surgical complication、the postoperative liver function、the recurrence rate of hemorrhage.Results:①The results of the operation situation studyAll the operations were successfully proceeded. The operative time was 143±42 minutes in laparoscopic surgery LS and 211±47 minutes in open surgery OS , which had a significant difference between the groups P0.05 .③The recurrence rate of hemorrhage during one yearThe recurrence rate of hemorrhage was 3.4% 1 cases in LS and 6.8% 2 cases in OS, which had no significant difference between the groups P 0.05 .④The results of the liver function studyThe postoperative Tbil was 17.6±8.6 μmmol/L in LS and 24.1±10.3 μmmol/L in OS, which had a significant difference between the groups P0.05 . The hand assistant laparoscopic splenectomy plus porta-agygous devascularization is feasible and safe for portal hypertension treatment,and has le