腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压并发食管胃底静脉曲张患者疗效研究*

doi:10.3969/j.issn.1672-5069.2023.02.027

Abstract

Abstract: Objective The aim of this study was to compare the laparoscopic and open splenectomy and pericardial devascularization in treatment of cirrhotics with esophageal varice (EV) and its impact on portal hemodynamics. Methods 45 cirrhotic patients with EV were enrolled in our hospital between March 2016 and March 2021, and 20 patients received open and another 25 patients received laparoscopic splenectomy and pericardial devascularization. Plasma endothelin (ET), angiotensin II (ATII) and plasma renin activity (PRA) were detected by radioimmunoassay. The portal vein flow (PVF), portal vein velocity (PVV), portal vein diameter (PVD) and hepatic arterial flow (HAF) were measured by Doppler ultrasonography. Results The operation time, intraoperative blood loss, blood transfusion volume, removal of drainage tube, postoperative exhaust and suture removal in patients receiving laparoscopic surgery were (213.5±20.7)min, (362.8±56.9)ml, (312.5±20.7)ml, (3.8±0.6)d, (2.7±0.4)d and (7.9±1.5)d, significantly different as compared to [(188.4±16.9)min,(415.2±50.7)ml, (349.4±23.6)ml, (5.1±0.9)d,(3.2±0.5)d and (11.3±2.1)d, respectively, P<0.05] in patients receiving open operation; at the end of one month after operation, the PVF, PVV, PVD and HAF in laparoscopic surgery-treated patients were (871.3±91.5)ml/min, (41.5±3.8)cm/s, (1.0±0.2)cm and (872.2±29.7) ml/min, not significantly different compared to [(904.7±87.3)ml/min, (39.7±3.4)cm/s, (1.1±0.2)cm and (881.6±30.5)ml/min, P>0.05] in open operation-treated patients; at the end of six months after surgery, there were no significant differences respect to liver function tests between the two groups (P>0.05); plasma ET, ATⅡ and PRA in laparoscopic surgery-treated patients were (74.7±5.1)ng/L, (143.3±7.6)ng/L and (71.5±7.9)ng/L, not significantly different compared to [(76.5±6.3)ng/L, (146.7±9.6)ng/L and (73.4±7.6)ng/L, respectively, P>0.05] in open operation-treated patients. Conclusion The laparoscopic splenectomy and pericardial devascularization might obtain the same efficacy of open operation in cirrhotics with EV, and the portal hemodynamics after operation is getting smooth.

Key words: Liver cirrhosis, Esophageal varice, Laparoscopic splenectomy, Pericardial devascularization, Portal hemodynamics

Li Jiaxing, Wu Lixia, Yin Chenglong, et al.. Laparoscopic splenectomy and pericardial devascularization in treatment of cirrhotics with esophageal varice and its impact on portal hemodynamics[J]. Journal of Practical Hepatology, 2023, 26(2): 258-261.

References

[1] Lyu Y, Bai W, Li K, et al. Anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis: a prospective observational study. Am J Gastroenterol, 2021, 116(7): 1447-1464.
[2] Zhang H, Zhang S, Zhang J, et al. Improvement of human platelet aggregation post-splenectomy with paraesophagogastric devascularization in chronic hepatitis B patients with cirrhotic hypersplenism. Platelets, 2020, 31(8): 1019-1027.
[3] Kang SH, Lee M, Kim MY, et al. The longitudinal outcomes of applying non-selective beta-blockers in portal hypertension: real-world multicenter study. Hepatol Int, 2021, 15(2): 424-436.
[4] Yang L, Zhang Z, Zheng J, et al. Long‐term outcomes of oesophagogastric devascularization and splenectomy in patients with portal hypertension and liver cirrhosis. ANZ J Surg, 2020, 90(11): 2269-2273.
[5] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张破裂出血的防治指南. 实用肝脏病杂志, 2016, 55(1): 57-72.
[6] 中华医学会消化病学分会, 肝病学分会, 内镜学分会. 肝硬化门静脉高压食管胃静脉曲张破裂出血的防治共识. 中华肝脏病杂志, 2008, 16(8): 564-570.
[7] 刘公伟, 吴雪, 唐聃, 等. 脾切除联合门奇静脉断流术治疗乙型肝炎肝硬化门脉高压症患者疗效研究. 实用肝脏病杂志, 2021, 24(5): 649-652.
[8] Boyer-Diaz Z, Aristu-Zabalza P, Andrés-Rozas M, et al. Pan-PPAR agonist lanifibranor improves portal hypertension and hepatic fibrosis in experimental advanced chronic liver disease. J Hepatol, 2021, 74(5): 1188-1199.
[9] 代坤甫, 马帅, 郝晓沛, 等. 腹腔镜脾切除联合贲门周围血管离断术对肝硬化门静脉高压症患者应激和免疫功能的影响. 中华普通外科杂志, 2019, 34(7): 609-612.
[10] Kreisel W, Schaffner D, Lazaro A, et al. Phosphodiesterases in the liver as potential therapeutic targets of cirrhotic portal hypertension. Int J Mol Sci, 2020, 21(17): 6223-6229.
[11] 韩东, 彭经纬, 谢辉晋. 脾切除联合贲门周围血管离断术治疗肝硬化门脉高压症患者预防门静脉血栓形成研究. 实用肝脏病杂志, 2020, 23(3): 409-412.
[12] 阿思根, 夏医君, 武慧军, 等. 脾切除术联合门奇静脉断流术治疗肝硬化门脉高压症患者疗效研究. 实用肝脏病杂志, 2020, 23(2): 248-251.
[13] Zheng D, Yu J, Li H, et al. Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series. Medicine, 2021, 100(27): e26610.
[14] Deng ZC, Jiang WZ, Chen L, et al. Laparoscopic vs. open splenectomy and oesophagogastric devascularisation for liver cirrhosis and portal hypertension: A retrospective cohort study. Int J Surg, 2020, 80(8): 79-83.
[15] Fujinaga A, Ohta M, Endo Y, et al. Clinical significance of splenic vessels and anatomical features in laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A, 2021, 31(6): 632-637.
[16] 谢飞, 王杰, 牟廷刚, 等. 不同时间窗抗凝对腹腔镜脾切除联合贲门周围血管离断术后患者门静脉血栓形成的预防作用. 中华肝胆外科杂志, 2019, 25(6): 435-438.
[17] Fernández J, Clària J, Amorós A, et al. Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis. Gastroenterology, 2019, 157(1): 149-162.
[18] Gelman S, Sakalauskas A, Zykus R, et al. Endogenous motion of liver correlates to the severity of portal hypertension. World J Gastroenterol, 2020, 26(38): 5836-5848.
[19] 蒋国庆, 柏斗胜, 金圣杰, 等. 改良保留迷走神经与传统腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的前瞻性随机对照研究. 中华消化外科杂志, 2020, 19(12): 1280-1285.
[20] 汪昱, 董科. 改良腹腔镜脾脏切除+贲门周围血管离断术在肝硬化合并门静脉高压症中的应用研究. 中华普外科手术学杂志: 电子版, 2021, 15(1): 65-68.
[21] Yao H, Wang Y. Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension. Open Life Sci, 2020, 15(1): 981-987.
[22] Simbrunner B, Semmler G, Stadlmann A, et al. Vitamin A levels reflect disease severity and portal hypertension in patients with cirrhosis. Hepatol Int, 2020, 14(6): 1093-1103.
[23] Artru F, Miquet X, Azahaf M, et al. Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT-based surveillance. Aliment Pharmacol Ther, 2020, 52(9): 1516-1526.

Laparoscopic splenectomy and pericardial devascularization in treatment of cirrhotics with esophageal varice and its impact on portal hemodynamics

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