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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 599 -603. doi: 10.3877/cma.j.issn.2095-3232.2021.06.014

临床研究

三种结扎方式在贲门周围血管离断术中应用的比较
陈世赓1, 梁明军1, 关蛟1, 周尊强1, 周光文1,†()   
  1. 1. 200233　上海交通大学附属第六人民医院普通外科
  • 收稿日期:2021-09-16 出版日期:2021-09-23
  • 通信作者: 周光文
  • 基金资助:
    国家自然科学基金(81974076)

Comparison of application of three ligation methods in pericardial devascularization

Shigeng Chen1, Mingjun Liang1, Jiao Guan1, Zunqiang Zhou1, Guangwen Zhou1,†()   

  1. 1. Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
  • Received:2021-09-16 Published:2021-09-23
  • Corresponding author: Guangwen Zhou
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陈世赓, 梁明军, 关蛟, 周尊强, 周光文. 三种结扎方式在贲门周围血管离断术中应用的比较[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 599-603.

Shigeng Chen, Mingjun Liang, Jiao Guan, Zunqiang Zhou, Guangwen Zhou. Comparison of application of three ligation methods in pericardial devascularization[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 599-603.

目的

比较传统丝线、Hem-o-lok夹和Endo-GIA 3种结扎方式在贲门周围血管离断术中的应用价值。

方法

回顾性分析2016年1月到2019年1月在上海交通大学附属第六人民医院行贲门周围血管离断术的60例肝硬化合并门静脉高压症患者临床资料。其中男23例，女37例；年龄35~65岁，中位年龄50岁。患者均签署知情同意书，符合医学伦理学规定。根据术中结扎方式不同将患者分为3组，32例采用丝线结扎（丝线组），10例采用Hem-o-lok夹夹闭（HL组），18例采用Endo-GIA切割闭合（EG组）。分析比较3组围手术期情况和术后并发症发生情况。3组手术时间、术中出血量、术后住院时间比较采用单因素方差分析，组间两两比较采用LSD-t检验。术后并发症发生率比较采用χ2检验。

结果

丝线组平均手术时间为（155±33）min，HL组为（144±21）min，EG组为（120±30）min，差异有统计学意义（F=6.153，P<0.05）。丝线组术中出血量为（242±27）ml，HL组为（169±15）ml，EG组为（119±16）ml，差异有统计学意义（F=8.574，P<0.05）。丝线组术后住院时间为（12.2±2.6）d，HL组为（10.8±2.4）d，EG组为（9.3±2.4）d，差异有统计学意义（F=4.158，P<0.05）。丝线组术后发生并发症7例，HL组2例，EG组3例，差异无统计学意义（χ2=0.25，P=0.87）。

结论

贲门周围血管离断术中采用Hem-o-lok夹、Endo-GIA或传统丝线结扎均具有较高的安全性，Hem-o-lok夹和Endo-GIA在减少手术时间、术中出血量和住院时间上更具优势。

关键词: 肝硬化, 高血压，门静脉, 贲门周围血管离断术
Objective

To compare the application of three ligation methods traditional silk thread, Hem-o-lok clip and Endo-GIA in pericardial devascularization.

Methods

Clinical data of 60 patientswith liver cirrhosis and portal hypertension who underwent pericardial devascularization in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University from January 2016 to January 2019 were retrospectively analyzed. Among them, 23 patients were male and 37 female, aged from 35 to 65 years, with a median age of 50 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different ligation methods used in the operation, all patients were divided into the silk thread group (n=32), Hem-o-lok (HL) group (n=10), and Endo-GIA (EG) group (n=18). Perioperative conditions and incidence of postoperative complications were statistically compared among three groups. The operation time, intraoperative blood loss and length of postoperative hospital stay were compared among three groups by using one-way ANOVA. Comparison between 2 groups was performed by LSD-t test. The incidence of postoperative complications was compared by Chi-square test.

Results

The average operation time in the silk thread group was (155±33) min, (144±21) min in the HL group and (120±30) min in the EG group, where significant differences were observed (F=6.153, P<0.05). The intraoperative blood loss in the silk thread group was (242±27) ml, (169±15) ml in the HL group and (119±16) ml in the EG group, where significant differences were observed (F=8.574, P<0.05). In the silk thread group, the length of postoperative hospital stay was (12.2±2.6) d, (10.8±2.4) d in the HL group and (9.3±2.4) d in the EG group, where significant differences were observed (F=4.158, P<0.05). In the silk thread group, 7 patients developed postoperative complications, and 2 cases in the HL group and 3 cases in the EG group, where no significant difference was observed (χ2=0.25, P=0.87).

Conclusions

Hem-o-lok clip, Endo-GIA or traditional silk thread ligation techniques are safe in pericardial devascularization, whereas Hem-o-lok clip and Endo-GIA have advantages in shortening operation time, reducing intraoperative blood loss and shortening the length of postoperative hospital stay.

Key words: Liver cirrhosis, Hypertension, portal, Pericardial devascularization
表1 丝线组、HL组和EG组肝硬化合并门静脉高压症患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） BMI（kg/m2，±s） Child-Pugh分级（例） 病因（例） Plt（×109/L，±s）
男 女 A B HBV肝硬化 HCV肝硬化 自身免疫性肝炎 血吸虫病肝硬化
丝线组 32 11 21 53±12 23.4±3.8 9 23 25 5 1 1 43.0±5.7
HL组 10 5 5 49±10 22.9±2.7 3 7 7 3 0 0 57.0±2.3
EG组 18 7 11 47±12 21.2±3.3 7 11 14 3 1 0 49.0±4.1
统计值   χ2=0.123 F=1.136 F=0.678 χ2=0.537 - F=2.343
P值   0.896 0.356 0.468 0.686 0.897 0.135
表2 丝线组、HL组和EG组肝硬化合并门静脉高压症患者围手术期情况比较（±s）
组别 例数 手术时间（min) 术中出血量（ml） 术后住院时间（d）
丝线组 32 155±33 242±27 12.2±2.6
HL组 10 144±21a 169±15a 10.8±2.4a
EG组 18 120±30b 119±16b 9.3±2.4b
F值   6.153 8.574 4.158
P值   <0.001 <0.001 0.008
表3 丝线组、HL组和EG组肝硬化合并门静脉高压症患者术后并发症发生情况（例）
组别 例数 出血 胸腹腔积液 膈下脓肿 胰漏
丝线组 32 1 4 0 2
HL组 10 0 0 1 1
EG组 18 0 3 0 0
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