全腹腔镜选择性贲门周围血管离断术的可行性

The feasibility of total laparoscopic selective pericardial devascularization

目的探讨全腹腔镜选择性贲门周围血管离断术治疗肝硬化门静脉高压症的可行性。方法回顾性分析2011年6月至2013年6月行全腹腔镜选择性贲门周围血管离断术治疗肝硬化门脉高压症合并上消化道出血的20例患者临床资料，并术后对患者进行随访，观察指标包括肝功能、再出血率和肝性脑病等。结果20例均在全腹腔镜下顺利完成。手术时间160～325min，平均242min。出血量50—750ml，平均229ml。术后住院7—16d，平均10d。术后1周肝功能基本正常。术后出现脾热3例，胸腔积液1例，中量腹水1例，应激性胃出血1例，均经对症治疗痊愈出院。20例患者随访1～24个月，平均11个月，1例发生门静脉血栓形成，肝功能均维持良好，无消化道再出血、肝性脑病发生。结论全腹腔镜选择性贲门周围血管离断术是治疗门静脉高压症一种安全、可行的微创方法，近期疗效理想。

Objective To evaluate the feasibility of laparoscopic selective pericardial devascularization for portal hypertension resulting from liver cirrhosis. Methods From June 2011 to June 2013, 20 patients with upper gastrointestinal bleeding and hypersplenism due to cirrhotic portal hypertension were treated in our hospital with laparoscopic selective pericardial devascularization. The clinic data was collected and retrospective analyzed. As follow-up, liver function, recurrence bleeding rate and hepatic encephalopathy were observed. Results All of the 20 operations were completed successfully under laparoscope. The mean operation time was 242 rain （ranged from 160 to 325 min）. The mean intraoperative blood loss was 229 ml （ranged from 50 to 750ml）. The mean postoperative hospital stay was 10 days （ranged from 7 to 16 days）.Liver function of postoperative day 7 recovery to normal. After the operation, three cases with spleen heat, one case wit left-sided pleural effusion, one case with medium- volume abdominal dropsy, and one case with stress gastrorrhagia, which were all alleviated after symptomatic treatment. With follow-ups of 1-24 months （mean time was 11 months） for 20 patients, one case got portal vein thrombosis, all patients remained well liver function, and no gastrointestinal bleeding reoccurred. Conclusions Laparoscopic selective pericardial devascularization was a safe, feasible and minimally invasive method for portal hypertension, with satisfactory short-mid-term result.