腹腔镜巨脾切除术

Laparoscopic splenectomy of the huge spleen

目的探讨腹腔镜脾切除术治疗乙肝后肝硬化门静脉高压脾功能亢进的方法和疗效.方法对8例乙肝后肝硬化门静脉高压脾功能亢进患者采用腹腔镜脾切除术.在腹部放置3个套管,脾周韧带及脾门用超声刀解剖,脾门血管用Endo GIA夹闭离断.结果 8例病人均顺利完成腹腔镜脾切除术,无中转开腹,无术后并发症发生.术后血小板明显上升,从平均36×109/L[(17～56)×109/L]升至437×109/L[(316～624)×109/L],随访7～24个月血小板均大于100×109/L.结论超声刀、Endo GIA等先进技术的应用已使腹腔镜脾切除术成为治疗乙肝后肝硬化门静脉高压脾亢有效的手术方法.

Objective To explre and discuss the method and therapeutic effect of laparoscopic splenectomy of portal hypertension and hypersplenism due to cirrhosis of the liver followed chronic hepatitis B. Methods Laparoscopic splenectomy was performed in 8 patients with portal hypertension and hypersplenism due to chronic cirrhosis after hepatitis type B infection. Three trocars were inserted into the the peritoneal cavity. The perisplenic ligaments and hilum of spleen were dissected with the ultrasonic dissector and the blood veeesls were separated and cut with Endo GIA stapler, Results Laparosopic splenectomies were successfully performed in six patients. There were no laparotomy in the course of the laparoscopic splenectomy and any post-operative complications. The platelet obviously elevated from the me, an 36 × 10^9/L [ （17 - 56） × 10^9/L] to 437 × 10^9/L [ （316 - 624） × 10^9/L]. In the 7 - 24 months of follow-up, platelet was all larger than 100× 10^9/L, Conclusion The application of the advanced instrument, such as ultrasonic dissector and GIA, etc., renders the laparoscopic splenectomy to be an effective method for the treatment of portal hypertension and hyperspenism due to chronic cirrhosis of liver followed hepatitis type B.