腹腔镜与开腹脾切除术在治疗肝硬化所致脾功能亢进中的对比研究

Comparison of laparoscopic and open splenectomy for treatment of hypersplenism caused by liver cirrhosis

摘要:

目的  比较研究腹腔镜脾脏切除术与开腹脾脏切除术在治疗肝硬化所致脾功能亢进中的临床疗效，为手术治疗肝硬化所致脾功能亢进提供参考。方法  选取2012年1月-2015年12月于该院手术治疗的46例肝硬化所致脾功能亢进患者为研究对象。采用随机数字表法分为观察组和对照组各23例，对照组行开腹脾脏切除术，观察组行腹腔镜脾脏切除术。比较两组手术相关指标、肝功能、炎症反应、免疫功能。结果  手术指标：观察组手术时间长于对照组，切口疼痛程度、拔管时间、术后住院时间均明显低于对照组[（101.38±26.25）min对比（76.14±15.36）min，（156.42±36.43）ml对比（180.50±48.19）ml，（2.50±0.79）切口疼痛程度对比（4.31±1.28）切口疼痛程度，（4.77±1.52）d对比（6.76±2.41）d，（7.79±1.28）d对比（11.03±2.73）d]（t =3.349～5.153，P <0.05）；肝功能：术后1 d时，观察组血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（Tbil）、直接胆红素（Dbil）均明显低于对照组[（43.32±4.52）u/L对比（46.365±5.36）u/L，（60.56±7.21）u/L对比（73.45±8.36）u/L，（27.52±3.42）μmol/L对比（34.28±4.25）μmol/L，（8.16±1.02）μmol/L对比（12.12±1.24）μmol/L]（t = 3.928～10.354，P <0.05）；术后7 d时，观察组ALT、AST、Dbil等指标明显低于对照组[（41.56±5.12）u/L对比（47.56±5.24）u/L，（37.75±4.52）u/L对比（54.42±6.25）u/L，（7.28±1.12）μmol/L对比（9.52±1.14）μmol/L]（t =3.928～10.354，P <0.05）；炎症反应免疫功能：术后1 d和3 d，观察组白细胞计数（WBC）、C反应蛋白（CRP）、CD8+均明显低于对照组[（13.18±2.31）×109/L对比（16.85±3.42）×109/L，（56.65±6.85）mg/L对比（74.25±8.35）mg/L，（24.12±3.24）%对比（26.14±3.45）%；（11.42±3.24）×109/L对比（15.32±3.36）×109/L，（38.64±4.35）mg/L对比（53.12±5.54）mg/L，（20.14±3.23）%对比（22.54±3.52）%]，CD4+、CD4+/CD8+明显高于对照组[（26.24±3.25）%对比（24.82±3.24）%，（1.46±0.32）%对比（1.34±0.28）%；（32.82±4.46）%对比（29.31±3.42）%，（1.65±0.28）%对比（1.50±0.31）%]（t =2.021～10.256，P <0.05）。结论  腹腔镜脾脏切除术有助缓解患者疼痛程度，减轻对肝功能的影响，降低炎症反应，保护免疫功能，促进患者术后恢复。

Abstract:

Objective To compare the clinical effect of laparoscopic splenectomy and open splenectomy in the treatment of patients with hypersplenism caused by liver cirrhosis so as to provide a reference for surgical treatment for liver cirrhosis-induced hypersplenism. Methods Forty-six patients who received surgical treatment for hypersplenism caused by liver cirrhosis from January 2012 to December 2015 were chosen as the research subjects, and were divided into observation group and control group (n = 23 in each group) using the random number table method. The control group underwent open splenectomy, while the observation group underwent laparoscopic splenectomy. Surgery related indicators, liver function, inflammatory reaction and immune function were compared between the two groups. Results The operation time of the observation group was longer than that of the control group (P < 0.05). The extubation time and postoperative hospitalization time of the observation group were significantly shorter than those of the control group (P < 0.05). The incision pain of the observation group was milder than that of the control group (P < 0.05). The detection of liver function revealed  serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total bilirubin and direct bilirubin (Dbil) levels were significantly lower than those of the control group 1 d after operation (P < 0.05); ALT, AST and Dbil levels in the observation group were significantly lower than those of the control group 7 d after operation (P < 0.05). Detection of inflammatory immune function showed 1 and 3 days after operation, white blood cell count (WBC), C reactive protein (CRP), and CD8+ T cell percentage of the observation group were significantly lower than those of the control group (P < 0.05) ; CD4+ T cell percentage and CD4+/CD8+ T cell ratio were significantly higher than those of the control group (P < 0.05). Conclusions Laparoscopic splenectomy is helpful in relieving pain of patients, reducing influence on liver function and inflammatory response, protecting immune function, and promoting recovery of patients after operation.