手助腹腔镜脾切除加贲门周围血管离断术治疗门静脉高压症

Modified hand-assited laparoscopic splenectomy plus pericardial devascularization for the treatment of cirrhotic portal hypertension

目的探讨改良手助腹腔镜下脾切除加贲门周围血管离断术治疗肝硬化门静脉高压症的临床应用价值。方法2009年3月至2011年12月共对47例肝硬化门静脉高压症患者行改良手助腹腔镜下脾切除加贲门周围血管离断术，先在手助腹腔镜下完成脾切除术，再改为完全腹腔镜下行贲门周围血管离断术。结果全组患者均完成改良手助腹腔镜下脾切除联合贲门周围血管离断术，无中转开腹，平均手术时间（154±32）min，术中平均出血量（115±73）ml，术后平均住院时间（9．2±1．6）d。围手术期并发症包括胸腔积液3例，腹水4例，胰漏1例，伤口裂开1例。无围手术死亡。结论改良手助腹腔镜下脾切除联合贲门周围血管离断术安全性好，操作方便，术中出血少。

Objective To evaluate the safety and efficacy of a modified hand-assited laparoscopic splenectomy （HALS） plus pericardial devascularization for the treatment of cirrhotic portal hypertension. Methods From March 2009 to Dec 2011, modified hand-assited laparoscopic splenectomy plus pericardial devascularization was performed on 47 patients with portal hypertension and liver cirrhosis. We performed HALS first, then converted to totally larparocopic pericardial devascularization during operation. Results All patients received modified HALS plus pericardial devascularization without convertion to open surgery, the mean operative time was （154 ± 32） min, the mean intraoperative blood loss was （115 ±73） ml, and the mean postoperative hospitalization was （9. 2 ±1.6） days. The perioperative complications included plural effusion in 3 cases, ascites in 4 cases, pancreatic leakage in 1 case and wound dehiscence in 1 case. There was no perioperative mortality. Conclusions Modified HALS plus pericardial devascularization is a relatively safe and effective procedure in the treatment of portal hypertension due to liver cirrhosis, it has the advantage of hand-assisted and totally laparoscopic procedures.