腹腔镜下脾切除加食管横断吻合术治疗门脉高压

Laparoscopic Splenectomy Combined with Lower Oesophagus Transection in the Treatment of Hepatic Cirrhosis Complicated with Portal Hypertension

目的探讨腹腔镜下脾切除加食管下端横断吻合术的可行性及优点。方法总结7例腹腔镜下脾切除术加食管下端横断吻合术患者的临床资料。结果6例在完全腹腔镜下完成,1例在手助腹腔镜下完成。其中1例中转开腹。平均手术时间330min,平均术中出血780ml。术后肠功能恢复时间平均70h,平均术后住院时间12.7天,术后不需镇痛,早期可下床活动。有1例术后发生脾窝积液和左侧胸腔积液,保守治疗后痊愈,术后无大出血、无胰漏。结论腹腔镜下脾切除加食管下端横断吻合术手术安全、可行、并发症少,腹腔镜使镜下操作视野清晰并放大,一些操作相对开腹手术更为简单和安全省时,但强调应由腹腔镜技术娴熟和有经验的医师完成。

Objective To study the short - term prognosis of laparoscopic splenectomy combined with lower esophagus transection in the treatment for hepatic cirrhosis induced portal hypertension. Methods The clinical data of 7 cases of portal hypertension treated by laparoscopic eplenectomy combined with lower esophagus transaction were retrospectively analysisd. Results Among of the patients,six cases were undertaken with total laparoscopic technique and only one case done with hand - assisted laparoscopic operation and one case turned to open surgery. Average operation time was 330 rain and operation hemorrhage was 780 ml. None of cases died,bled or occurred pancreatical fistula. Mean time of bowel function recovery （70 h） and postoperative hospitalization （12.7 d）. 1 case complicated with hydrothorax recovered after conservative therapy. Conclusion Cincial short - term effects of patients treated with laparoscopic splenectomy combined with lower esophagus transection for hepatic cirrhosis induced portal hypertension is satisfied, so it is a safe and feasible way for future clin- ical practice if conducted by the skilled and competent surgeon.