探讨以腹腔镜脾切除联合贲门周围血管离断术（断流术）为中心的门静脉高压症微创手术全程管理模式的应用价值。

回顾性分析2009年1月至2018年12月在空军军医大学附属唐都医院行断流术的263例肝硬化门静脉高压症患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男159例，女104例；年龄17~77岁，中位年龄46岁。根据管理模式不同，将患者分为新模式组（129例）和对照组（134例）。新模式组采用以腹腔镜断流术为中心的微创手术全程管理。对照组采用以开腹断流术为中心的传统围手术期管理模式。观察两组围手术期情况和并发症情况。两组围手术期指标比较采用秩和检验或t检验，并发症发生率比较采用χ²检验。

新模式组术中出血量为562（500）ml，明显少于对照组的1 405（900）ml（Z=-9.472，P<0.05）；引流管留置时间及术后住院时间分别为（4.2±2.3）、（7.7±3.0）d，亦明显少于对照组的（6.3±2.7）、（9.6±2.9）d（t= -6.778，-5.223；P<0.05）。新模式组术后3 d的AST、TB分别为33（17）U/L、24（13）μmol/L，明显少于对照组的41（21）U/L、40（22）μmol/L（Z=-2.708，-4.775；P<0.05）；PT为（13.5±1.5）s，亦明显少于对照组的（16.3±2.8）s （t=-8.594，P<0.05）。新模式组术后严重并发症发生率为15%（19/129），明显低于对照组的51%（68/134） （χ²=38.520，P<0.05）。

以腹腔镜断流术为中心的门静脉高压症微创手术全程管理模式是安全、有效的，可保证患者围手术期安全、降低手术并发症及促进患者快速康复。

To evaluate the application value of the full-process management of minimally invasive surgery, primarily laparoscopic splenectomy combined with pericardial devascularization (devascularization), for portal hypertension.

Clinical data of 263 patients with cirrhosis complicated with portal hypertension undergoing devascularization in Tangdu Hospital Affiliated to Air Force Medical University from January 2009 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 159 patients were male and 104 female, aged 17-77 years with a median age of 46 years. According to different managements, all the patients were divided into the new mode group (n=129) and control group (n=134). In the new mode group, the full-process surgery management of laparoscopic devascularization was adopted. In the control group, traditional perioperative management of open devascularization was performed. Perioperative conditions and complications were observed between two groups. Perioperative conditions were statistically compared between two groups by rank-sum test or t test. The incidence of complications was compared by Chi-square test.

In the new mode group, intraoperative blood loss was 562(500) ml, significantly less than 1 405(900) ml in the control group (Z=-9.472, P<0.05); The indwelling time of drainage tube and length of postoperative hospital stay were (4.2±2.3) d and (7.7±3.0) d, significantly shorter than (6.3±2.7) d and (9.6±2.9) d in the control group (t=-6.778, -5.223; P<0.05). In the new mode group, the AST and TB levels at postoperative 3 d were 33(17) U/L and 24(13) μmol/L, significantly lower than 41(21) U/L and 40(22) μmol/L in the control group (Z=-2.708, -4.775; P<0.05); PT was (13.5±1.5) s, significantly shorter than (16.3±2.8) s in the control group (t=-8.594, P<0.05). The incidence of severe postoperative complications in the new mode group was 15%(19/129), significantly lower compared with 51%(68/134) in the control group (χ²=38.520, P<0.05).

The full-process management of minimally invasive surgery, mainly laparoscopic devascularization, is safe and efficacious for portal hypertension, which can guarantee the perioperative safety, reduce the risk of surgical complications and accelerate recovery of patients.