腹腔镜门奇静脉联合断流术

Laparoscopic portozygos disconnection procedure in portal hypertension

目的探讨腹腔镜门奇静脉联合断流术的手术方法和临床效果。方法回顾分析我院2002年10月至2006年10月间28例腹腔镜下门奇静脉联合断流术的手术时间、术中失血量、术后并发症等。结果28例中25例腹腔镜手术成功,其中5例完全在腹腔镜下完成,20例在手助下完成。3例中转开腹。腹腔镜手术时间150～280min,平均220min。术中出血400～1700ml,平均790ml。切除脾500～1900g,平均780g。腹腔镜手术患者住院时间9～19d,平均10.6d。术后患者恢复顺利,疼痛少,无死亡病例。结论腹腔镜行门奇静脉联合断流术不但安全可行,而且具有微创手术的优点,但需正确掌握手术适应证,可根据不同的病情选择不同的手术方式。

Objective To summarize the surgical technique and clinical efficacy of laparoscopic portozygos disconnection procedure in portal hypertension. Methods The data of 28 patients undergone laparoscopic splenectomy plus portozygos disconnection procedure from Oct. 2002 to Oct. 2006 were reviewed. Results Twenty-five of the 28 patients were operated successfully, 5 patients underwent the operation with laparoscopy and 20 patients underwent hand-assisted laparoscopic operation. The other 3 patients were converted to open laparotomy. The mean operative time was 220 min （150-280 min）, the mean blood loss was 790 ml （400- 1 700 ml）, the mean weight of spleen was 780 g （500-1 900 g） and the mean duration of hospitalization was 12 days （9-19 days）. All patients recovered rapidly with less pain. No death occurred. Conclusion Laparoscopic portozygos disconnection procedure in portal hypertension is not only feasible and safe but also has the merits of minimally invasive surgery. It is necessary to grasp the indication of operation correctly and choose different method of operation depending on patients＇ condition.