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临床分析

Laparoscopic splenectomy plus pericardial devascularization for portal hypertension

目的探讨腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症的临床效果。方法门静脉高压症行腹腔镜巨脾切除联合门奇离断术患者19例,分析术中不同脾蒂处理方式及治疗结果。结果 19例术中食管下端贲门周围血管离断长度均>8cm,出血量(295.0±35.4)mL;11例行Endo-GIA集束离断脾蒂,无中转开腹;8例行二级脾蒂离断术,其中2例改行Endo-GIA离断手术,1例因大出血中转开腹治疗;行二级脾蒂离断者术后并发胸腔积液2例、门静脉血栓形成及胰尾损伤各1例,行Endo-GIA集束离断者术后并发胸腔积液3例,均经对症治疗后痊愈。结论腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症安全、可行;应用Endo-GIA集束离断脾蒂可增加手术的安全性。

Objective To evaluate the effect of total laparoscopic splenectomy plus pericardial devascularization on the portal hypertension. Methods Nineteen patients with portal hypertension undergoing laparoscopic spleneetomy plus porta-azygous devascularization were retrospectively analyzed the different processing methods of spleen pedicle and the operation results. Results The length of devasularized esophagus was over 6 cm and the mean blood lose was （295.0±35.4） mL in all patients. Eleven patients were successfully performed Endo-GIA. Eight patients underwent spleen subpedicle severance, in which 2 patients were converted to Endo-GIA, and 1 was converted to laparotomy surgery. Pleural effusion occurred in 2, pancreatic injury in 1, and portal vein thrombosis in 1 patient after spleen subpedicle severance. Pleural effusion occurred in 3 patients after Endo-GIA. And all the complications were cured after symptomatic treatment. Conclusions Total laparoscopic splenectomy plus perieardial devascularization is safe and effective for portal hypertension. The use of Endo-GIA can reduce the operation difficulty and improve the safety.