手助下腹腔镜脾切除贲门周围血管离断术治疗门脉高压症脾功能亢进、食管及胃底静脉曲张破裂出血

Clinical application of hand-assisted laparoscopic megalosplenic resection and portozygos disconnection for portal hypertemsion,hypersplenism and spontaneously ruptured varicosity of esophagus and funds of stomach

目的为减轻手术对肝硬化门脉高压症病人创伤,减少术中出血,保护肝脏功能,减少并发症的发生,采用手助下腹腔镜微创技术进行脾切除、贲门周围血管离术,治疗门脉高压症脾功能亢进、食管及胃底静脉曲张破裂出血。方法右侧卧位,内镜置于脐部,左手经上腹左侧约7cm长的经腹直肌切口伸入腹腔,左肋弓下腋前线置10cm Trocar,经此操做孔应用超声刀、ligasure等各种器械与左手配合完成脾切除及门奇断流术。结果本组35例,脾切除加贲门周围血管离断术33例,脾切除加胆囊切除2例,术后切口液化3例,腹水12例。结论应用手助腹腔镜技术行脾切除、贲门周围血管离断术,缩短了腹壁切口长度,开阔了食管、胃底、脾上极深在部位的视野,方便操作,腹腔干扰轻,出血少,是一种非常可取的手术方法。

Objective To lighten the operative trauma of the patients with cirrhosis of liver and portal hypertension,to reduce the amount of bleed during operation,To protect the liver function,to reduce the complications,to adopt hand-assisted laparoscopic megalosplenic resection and portozygos disconnection(HLMRPD)for portal hypertemsion,hypersplenism and spontaneously ruptured varicosity of esophagus and funds of stomach.Methods The patients lie on their right under general anesthesia.We place laparoscopy in umbilicus,the left hand stretches into the abdominal cavity through a rectus abdominis'incision which is in the left of upper abdomen 7 cm.The left hand coordinates with the apparatuses of harmonic scalpel and ligasure etc,We complete megalosplenic resection and portozygos disconnection.Results Among 35patients,33patients were performed with megalosplenic resection and portozygos disconnection,2patients were performed with laparoscopic slenectomy and cholecysterctomy,3cases incisions liquify,12cases abdomen have water.Conclusion HLMRPD can shorten the length of the incision and widen the field of vision of esophagus,fundus of stomach and the utmost point of spleen.It has advantages of little blood loss,light disturb,convenient operation.