利用弧型切割缝合器微出血下实施门脉高压断流手术的探讨

Investigation of Minibleeding Pericardial Vascular Disconnection with Curved Cutter Stapler in Patients of Portal Hypertension

目的探讨应用一次性弧型切割缝合器行脾脏切除、贲门周围血管离断术的方法及疗效。方法采用病例对照研究,研究组胃底食管静脉曲张患者22例,均接受脾脏切除、贲门周围血管离断术,术中脾脏动脉结扎后离断脾结肠、脾胃韧带,将脾蒂完全置入弧型切割缝合器中,一次性完成切割缝合脾蒂,并利用血管闭合器阻断贲门周围血管。选择同期接受传统手术方法的22例作为对照组。结果研究组手术出血量平均(33.41±13.22)ml;对照组平均(843.63±646.60)ml;研究组手术时间平均(77.50±18.38)min,对照组平均(140.95±40.42)min,两组手术出血量及手术时间比较差异显著(P<0.01)。研究组无严重并发症,对照组发生血栓性门静脉炎2例,经对症支持治疗后好转,余恢复顺利。结论利用一次性切割缝合器离断脾蒂及相应系膜血管,利用血管闭合器阻断贲门周围血管,安全可靠,可显著提高手术速度,减少手术出血和创伤,值得推广试用。

Objective To investigate the splenectomy and pericardial vascular disconnection with curved cutter stapler in patients with hepatic portal hypertension under the circtmistance of minibleeding. Methods 22 cases with hepatic portal hypertension were selected as study group, who underwent splenectomy and paraesophagogastric devascularization. The splenic pedicle was dissected and sewed up simultaneously by the curved cutter stapler. The paraesophagogastric vessels were blocked with vessel closer. Another 22 cases of hepatic portal hypertension who underwent traditional procedure were selected as control group. Results The intraoperative blood loss of the study group was （ 33.41± 13.22） ml, which was significantly lower than （ 843.63± 646.60） ml of the control group （ P 〈 0.01 ）. And the operation time of the study group was （77.50 ± 18.38 ） minutes, which was significantly shorter than （140.95± 40.42 ）rain of the control group（ P 〈 0.01 ）. There was no severe complication happened in the study group, whereas 2 cases of pylethrombophlebitis occurred in the control group, and got improved after supportive treatment. Conclusion It is reliable and safe to perform the splenectomy and pericardial vascular disconnection with curved cutter stapler in patients with hepatic portal hypertension with the advantages of short operative time and little blood loss, which is worthy to be popularized.