关键词:

腹腔镜,  , 脾切除术,  , 肝硬化,  , 内镜曲张静脉套扎术

Abstract:

Objective To investigate the different efficacy of endoscopic esophageal variceal ligation combined with laparoscopic splenectomy and pericardial devascularization versus modified Sugiura operation and Hassab′s operation for esophageal and gastric variceal hemorrhage in liver cirrhosis. Methods In this study，we retrospectively analyzed the clinical data of 78 liver cirrhosic patients with esophageal gastric variceal hemorrhage who met the inclusion and exclusion criteria，23 cases in the EVL + LSD group，30 cases in the modified Sugiura group，and 25 cases in the Hassab′s group. We compared the differences among the three groups in terms of opera⁃ tion time，intraoperative blood loss，hospitalization time，hospitalization cost，rate of complications，incidence of portal vein thrombosis on the seventh day after surgery，recovery of liver function on the first，third and seventh days after surgery，and recurrence rate of varicose veins at 1 and 2 years after surgery. Statistical analysis was per⁃ formed using SPSS 26.0：Levene′s test of homogeneity of variance was performed，with the measurement variables of homogeneity of variance expressed as the mean ± standard deviation（SD）and compared with one⁃way analysis of variance（ANOVA），and then pairwise comparison was performed using Scheffe method；For the measurement variables not meeting the homogeneity of variance，the median（interquartile range）was computed and median test was performed. Categorical variables were compared with the Kruskal⁃Wallis⁃H test and Mann⁃Whitney U method for pairwise comparison. Ordinal variables were compared with Jonckheere⁃Terpstra test. P < 0.05 was considered statistically significant. Results There was no significant difference in intraoperative blood loss and the incidence of portal vein thrombosis on the seventh day after surgery among the three groups（P > 0.05）. The EVL + LSD group had faster post⁃operative recovery of liver function，earlier resumption of anal venting，shorter hospitalization time，fewer post⁃operative incision infections，and lower recurrence rate of varicose veins at 1 and 2 years after sur⁃ gery，but longer operation time and higher hospitalization cost than the other groups，with significant differences statistically（P < 0.05）. Conclusions Endoscopic variceal ligation combined with laparoscopic splenectomy for peripancreatic vascular dissection has the advantages of less trauma，faster recovery of liver and gastrointestinal functions，shorter hospitalization time，and lower recurrence rate of varices 1 and 2 years after surgery than the modified Sugiura operation and Hassab′s operation，and moreover the incidence of postoperative complications and portal vein thrombosis on the seventh day after surgery is not increased，so it is suitable for promotion and applica⁃ tion in hospitals eligible with technical provisions.

Key words:

laparoscopy, splenectomy, liver cirrhosis, endoscopic variceal ligation