全腹腔镜贲门周围血管离断术治疗门脉高压症

Laparoscopic Pericardial Devascularization for Portal Hypertension

目的探讨全腹腔镜下贲门周围血管离断术的技巧和方法。方法 2007年5月~2010年10月,采用完全腹腔镜方法,对34例肝硬化门脉高压并上消化道出血的患者行贲门周围血管离断术。术中切脾方法采用一级脾蒂离断法或者二级脾蒂离断法,断流方法采用选择性或非选择性贲门周围血管离断术。结果 33例在全腔镜下完成（其中2例为选择性贲门周围血管离断术）,1例需手助。手术时间170~430 min,平均250 min。术中失血100~1000 ml,平均533 ml。1例术后肝功能衰竭死亡。33例术后住院8~20 d,平均10.6 d。30例术后随访3~25个月,平均13个月,2例再出血,1例原发性肝癌。结论全腹腔镜下贲门周围血管离断术治疗门脉高压症是一种安全、微创、可行的方法。

Objective To investigate the techniques of laparoscopic pericardial devascularization for portal hypertension.Methods From May 2007 to Oct 2010,34 patients with cirrhotic portal hypertension complicated with upper gastrointestinal bleeding received selective or non-selective pericardial devascularization by using laparoscopy in our hospital.Primary or secondary structures of the splenic pedicle were cut for splenectomy during the operation. Results The laparoscopic pericardial devascularization was successfully performed in 33 patients（the paraesophageal vessels were reserved in 2 of them）;hand-assisted procedure was required in the other.The mean operation time was 250 min in the series（ranged from 170 to 430 min）.The mean intraoperative blood loss was 533 ml（ranged from 100 to 1000 ml）.One case of postoperative mortality occurred because of liver failure.The patients were discharged from our hospital in 8 to 20 days after the operation（mean,10.6 days）.After that,30 of the patients received follow-up for a mean of 13 months（ranged 3 to 25 months）.During the follow-up,two patients showed hemorrhage and one patient developed primary hepatocellular carcinoma. Conclusion Laparoscopic pericardial devascularization is feasible,safe,and minimally invasive for cirrhotic portal hypertension.