腹腔镜胆囊切除术中合并门静脉海绵样变性的处理体会(附10例报告)

Management experience of cavernous transformation of the portal vein during laparoscopic cholecystectomy:with a report of 10 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术中合并门静脉海绵样变性(cavernous transfor-mation of the portal vein,CTPV)的处理方法。方法:回顾分析2009年7月至2012年6月为10例胆囊良性疾病合并CTPV患者行LC的临床资料。9例患者于术前经彩色多谱勒超声、CT及DSA检查明确合并CTPV;1例患者术中发生大量出血,中转开腹证实合并CTPV并门静脉右支纵行劈裂损伤。结果:7例患者顺利完成手术,3例中转开腹。手术时间45～130 min,平均(60±15)min;术中出血量5～100 ml,平均(65±25)ml。术后1例发生毛细胆管漏,余者均无胆漏、出血等并发症发生。患者均顺利出院,术后平均住院(3.2±1.0)d。结论:术前明确诊断,术中仔细辨别变性迂曲血管,必要时行预防性缝扎止血,解剖困难时及时中转开腹,为合并门静脉海绵样变性的患者行LC是可行的。

Objective：To discuss the management methods for patients complicated with cavernous transformation of the portal vein （CTPV） during laparoscopic cholecystectomy （LC）. Methods：The clinical data of 10 patients who suffered with benign gallbladder diseases combined with CTPV and underwent LC from Jul. 2009 to Jun. 2012 were retrospectively analyzed. Among the 10 cases, CTPV was diagnosed by color doppler ultrasonography, CT and digital subtraction angiography preoperatively in 9 patients. One patient with uncontrolled hemorrhage was confirmed as CTPV and right portal vein longitudinal splitting damage by conversion to laparotomy. Results：LC was successfully accomplished in 7 cases, and conversion to laparotomy occurred in 3 cases. The operative time was 45- 130 min, mean （60 ± 15 ） min;the intraoperative blood loss was 5-100 ml, mean （65 ± 25 ） ml. Capillary biliary fistula occurred in one case. No complications such as biliary leakage or bleeding occurred in other cases. All the patients were discharged uneventfully. The postoperative mean hospital stay was （3.2 ± 1.0） d. Conclusions： LC is feasible for patient with CPTV on condition that confirmed preoperative diagnosis, careful distinguishing varices,preventive intraoperative transfixion for hemostasis when necessary, and conversion to open surgery timely in difficult dissection.