腹腔镜下改良Sugiura手术治疗门静脉高压症的临床研究

The clinical research of laparoscopic modified sugiura procedure for the treatment of portal hypertension

目的探讨腹腔镜下改良Sugiura手术治疗肝硬化门静脉高压症的方法、技巧,对腹腔镜下完成该手术的安全性、可行性及手术效果加以评估。方法回顾性分析2004年3月~2010年8月共15例诊断为肝硬化门静脉高压症患者行腹腔镜下改良Sugiura手术的临床资料。观察术前、术后血常规变化,术前、术后食管胃底静脉曲张程度及再出血等情况。结果全部病例均能在腹腔镜下完成手术,8例采用上腹部辅助小切口,7例完全腹腔镜下完成,无中转开腹者。平均手术时间6.07 h,出血量平均672 mL。术后有1例患者死亡,其余患者恢复顺利,无严重并发症发生,血细胞恢复正常（P〈0.05）,食管胃底静脉曲张程度减轻（P〈0.05）,平均随访36个月,有1例患者于术后2年有排黑便,余患者无再出血。结论腹腔镜下改良Sugiura手术治疗门静脉高压症效果确切,在具有良好的腹腔镜手术经验及技巧的团队中进行是安全、可行的。

【Objective】To study the methods and skills of laparoscopic modified sugiura procedure for the treatment of portal hypertension in cirrhotic patients and evaluate the feasibility, safety and operation effect of this procedure.【Methods】15 patients diagnosed as cirrhosis, portal hypertension received laparoscopic modified sugiura were reviewed retrospectively from March 2004 to August 2010,. the change of blood routine,degree of gastroesophageal varices, rebleeding was observed.Statistical software SPSS 13.0 was used for statistical analysis,default P 0.05 as statistically significant difference. 【Results】The operations were successful in all 15 patients,and no case was transferred to opening appendectomy. The average operative time was 6.07 hours, Mean blood loss was 672ml.The patients recovered well and without any severe complications except 1 died after surgery, blood cells restored normal（P 0.05）, degree of gastroesophageal varices were reduced（P 0.05）, mean follow-up time was 36months, one patient passed black stool after 2 years. 【Conclusions】Laparoscopic modified Sugiura procedure is feasible and safe, laparoscopic modified Sugiura procedure offers a new alternative for the treatment of portal hypertension, but this procedure should be performed in the team with good experience in laparoscopic surgery and skills.