关键词: 腹腔镜下脾切除术, 内镜下序贯套扎及硬化剂治疗, 门静脉高压症, 疗效, 血流动力学, 预后

Abstract: Objective To investigate the analysis of clinical efficacy、hemodynamic indexes and prognosis of laparoscopic splenectomy and Endoscopicvariceal ligation and sclerotherapy in the treatment of portal hypertension patients. Methods From August 2015 to January 2018, 91 patients with PHT were admitted,according to the treatment were divided into control group(n=45) and group(n=46),the control group using cardiac blood vessels around from surgery combined therapy with laparoscopic splenectomy,the team used laparoscopic splenectomy in combination with endoscopic sequential ligation and hardener treatment,compared two groups of clinical curative effect. Results The intraoperative bleeding(241.1±82.0)ml,postoperative abdominal drainage(473.8±122.3)ml,postoperative anal venting time(2.1±0.5)d,awake rate(15.2%) and postoperative hospital stay(11.3±2.2)d in the study group were better than those in the control group[(363.4±118.2)ml,(677.5±154.0)ml,(3.5±0.9)d,35.6% and (16.0±3.4)d](P<0.05).The postoperative serum inflammatory indexes[TNF-α:(38.1±9.3)ng/L,IL-6:(27.6±7.2)ng/L and CRP:(41.6± 11.2)mg/L] and hemodynamic parameters[PVP:(21.5±1.5)mmHg,PVV:(18.7±2.7)cm/s,PVD:(11.4±0.5)mm and PVF:(535.7±90.6)ml/min] compared with the control group[TNF-α:(73.0±11.1)ng/L,IL-6:(40.3±4.4)ng/L and CRP:(68.4±12.0)mg/L;PVP:(25.4±1.8)mmHg,PVV:(19.4±3.0)cm/s,PVD:(13.2±0.6)mm and PVF:(739.4±93.8)ml/min](P<0.05).After six months,there was not statistically significant in sithe Child-Pugh score compared with the two groups(P>0.05). Conclusion The laparoscopic splenectomy and EVLS therapy in the treatment of portal hypertension patients has a better therapeutic effect, which can not only reduce the inflammatory response of patients, but also have little influence on hemodynamics and prognosis.

Key words: laparoscopic splenectomy, endoscopicvariceal ligation and sclerotherapy, portal hypertension, clinical efficacy, hemodynamic indexes, prognosis