本文關鍵詞： 腹腔鏡脾切除 肝硬化 門靜脈高壓 門奇靜脈斷流術　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:在腹腔鏡技術輔助下,采用全新的手術方案治療肝硬化門脈高壓癥導致的食管下段、胃底血管曲張、脾腫大、脾功能亢進,對比開腹下行門奇靜脈斷流術傳統(tǒng)方案的療效,揭示出新方案在安全性、可行性方面的表現(xiàn)。方法收集2002-2016年我院普外科行門奇靜脈斷流術治療門脈高壓患者35例。將患者分為兩組:其中,腹腔鏡組15例患者接受完全腹腔鏡下行門奇靜脈斷流術聯(lián)合脾切除術治療;傳統(tǒng)開腹組20例行開腹門奇靜脈斷流術聯(lián)合脾切除,從平均住院時間、手術時間、術中出血量、手術費用、拔管時間、術后2天引流管引流量及排氣間隔的時間變化,血液學、生化檢查方面比較二者的術后72小時的肝功能、白蛋白、血糖、血小板、白細胞以及血紅蛋白等指標的變化情況。結果兩種手術方式在費用、血紅蛋白以及血小板變化方面不具有顯著性差異(p0.05);平均住院時間、術中出血量、拔管時間、術后2天引流管引流量及排氣時間均優(yōu)于開腹組(p0.05);圍手術期谷丙轉氨酶、總膽紅素、白蛋白、血糖值以及白細胞變化腹腔鏡組均小于開腹組(p0.05);手術時間上開腹組優(yōu)于腹腔鏡組(p0.05)結論:完全腹腔鏡下行門奇靜脈斷流術聯(lián)合脾切除術與傳統(tǒng)開腹下行門奇靜脈斷流術聯(lián)合脾切除手術相比更具有優(yōu)勢。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.34
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本文編號：1494200