腹腔镜脾切除贲门周围血管离断术治疗门脉高压症的临床体会

Totally laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension

目的:探讨腹腔镜脾切除联合断流术治疗门静脉高压症的手术技巧及临床应用价值。方法:回顾分析2012年1月至2013年4月为135例门静脉高压症患者行腹腔镜脾切除联合贲门周围血管离断术的临床资料。结果:6例由于术中出血难以控制而中转开腹,129例顺利完成腹腔镜手术。手术时间150～270 min,平均(195.9±24.4)min;术中出血量150～1 000 ml,平均(346.1±112.2)ml;术后住院5～9 d,平均(6.3±0.6)d。2例由于术后腹腔出血行二次手术,1例术后腹腔出血非手术治疗。术后发生胰漏1例,肺部感染1例,胸腔积液1例,均经保守治疗痊愈。术后随访3～18个月,均无近期消化道再出血。结论:腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症是安全、可行的,具有患者创伤小、术后康复快、疗效确定等优点。术前认真选择患者,固定手术组人员,根据术者经验灵活处理各种情况,尤为重要。

Objective：To investigate the technique and clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension. Methods：The clinical data of 135 patients of portal hypertension who underwent laparoscopic spleneetomy combined with pericardial devascularization between Jan. 2012 and Apr. 2013 were retrospectively analyzed. Results：Laparoscopic spleneetomy combined with pericardial devascularization was successfully performed for 129 patients. 6 cases were converted to open surgery due to intraoperative intractable bleeding. The surgery time was 15-270 min, with the average of （195.9 ± 24.4） min. The blood loss was 150-1 000 ml, average （346.1 ± 112.2） ml. The postoperative hospital stay was 5-9 d, average （ 6.3 ± 0.6） d. Two cases underwent the second operation because of the intra-abdominal hemorrhage after the first one. 1 case of the intra-abduminal hemorrhage underwent non-operative treatment. Other postoperative complications included pancreatic leakage in 1 case, pneumonia in 1 case, pleural effusion in 1 case. And all were cured by non-operative treatments. No upper gastrointestinal rebleeding occurred during follow-up period of 3 to 18 months. Conclusions：The laparoscopic spleneetomy combined with perieardial devascularization for the treatment of portal hypertension is a safe and feasible procedure. It has the advantages of less invasion, quicker recovery and better effect. It is particularly important to carefully select patients preoperatively ,fix operation group ,flexibly deal with any case ac- cording to the surgical experience.