关键词: 肝硬化, 门静脉高压症, 腹腔镜断流术, 脾切除, 脾保留, 预后

Abstract: Objective To analyze the outcomes of laparoscopic esophagogastric devascularization and splenectomy or preserving spleens in patients with cirrhotic portal hypertension. Methods 60 patients with cirrhotic portal hypertension were divided into the splenectomy group （n=30） and spleen preservation group （n=30） according to the operation carried out. Results At the end of two weeks after operation,the diameter of portal veins and blood flow volumes in the splenectomy group were（1.1±0.2） cm and（820.1±101.1） ml/min, significantly narrower or smaller than those in the spleen preservation group [（1.3±0.2） cm and （941.0±188.1） ml/min, P<0.05],while the average blood flow velocity [（19.2±3.1） cm/s] was significantly higher than that in the spleen preservation group [（16.2±2.5） cm/s,P< 0.05];serum levels of laminin in the splenectomy group 3 month after operation was （100.9±29.1） ng/L,significantly lower than that in the spleen preservation group [（126.7±30.1） ng/L,P<0.05];the incidence rates of portal venous thrombosis,gastrointestinal bleeding and ascites in the splenectomy group during follow-up were 3.3%,0.0%,10.0%,much lower than those in the spleen preservation group （16.7%,26.7%,33.3%,P<0.05）;during the follow-up period,2（6.7%） patients in the spleen preserving group died. Conclusion The spleen preservation must be carefully taken in laparoscopic devascularization in patients with liver cirrhosis and portal hypertension,which might lead to severe outcomes in this setting.

Key words: Liver cirrhosis, Portal hypertension, Laparoscopic devascularization, Splenectomy, Spleen preservation, Prognosis