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Abstract：
BACKGROUND: The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.
OBJECTIVE: To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function.
METHODS: Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups.
RESULTS: The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences.
CONCLUSIONS: TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.
OBJECTIVE: To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function.
METHODS: Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups.
RESULTS: The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences.
CONCLUSIONS: TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.
摘要：
背景：门静脉高压（PH）引起的肝脏血流动力学变化与各种并发症密切相关，例如胃食管静脉曲张和门静脉分流，这可能会导致这些患者的不良临床结局，因此寻找临床疗效好、并发症风险低的治疗策略具有重要的临床意义。
目的：探讨全腹腔镜脾切除术(TLS)治疗PH的临床疗效及其对肝血流动力学和肝功能的影响。
方法：在2016年10月至2020年10月收治的199例PH患者中，100例[观察组]接受TLS治疗，其余99例[参照组(RG)]行开腹脾切除术(OS)。观察比较两组临床疗效,手术指标[手术时间（OT）和术中出血量]，安全性（腹膜内出血，腹水感染,饮食失调,肝功能不全,和围手术期死亡)，肝血流动力学(直径，速度,和门静脉系统的流量)，和肝功能[血清丙氨酸转氨酶（ALT），血清天冬氨酸转氨酶（AST），两组血清总胆红素(TBil)]。
结果：与RG相比，OG的OT明显延长，术中出血量明显减少。此外,总反应率，术后并发症发生率,和肝功能指标(ALT，AST,和TBil）在OG和RG之间没有显着差异。肝脏血流动力学统计显示，两组患者术前和术后血管直径无统计学差异。尽管术后血流速度和血流量与术前相比明显下降，组间无显著差异.
结论：TLS有助于相当的临床疗效，安全,肝血流动力学,和OS在治疗PH时的肝功能，有较长的OT，但术中失血较少。
目的：探讨全腹腔镜脾切除术(TLS)治疗PH的临床疗效及其对肝血流动力学和肝功能的影响。
方法：在2016年10月至2020年10月收治的199例PH患者中，100例[观察组]接受TLS治疗，其余99例[参照组(RG)]行开腹脾切除术(OS)。观察比较两组临床疗效,手术指标[手术时间（OT）和术中出血量]，安全性（腹膜内出血，腹水感染,饮食失调,肝功能不全,和围手术期死亡)，肝血流动力学(直径，速度,和门静脉系统的流量)，和肝功能[血清丙氨酸转氨酶（ALT），血清天冬氨酸转氨酶（AST），两组血清总胆红素(TBil)]。
结果：与RG相比，OG的OT明显延长，术中出血量明显减少。此外,总反应率，术后并发症发生率,和肝功能指标(ALT，AST,和TBil）在OG和RG之间没有显着差异。肝脏血流动力学统计显示，两组患者术前和术后血管直径无统计学差异。尽管术后血流速度和血流量与术前相比明显下降，组间无显著差异.
结论：TLS有助于相当的临床疗效，安全,肝血流动力学,和OS在治疗PH时的肝功能，有较长的OT，但术中失血较少。
