腹腔镜脾切除术贲门周围血管离断术的应用体会

Application experience of laparoscopic splenectomy combined with pericardial devascularization

目的：探讨腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的手术技巧与临床应用价值。方法：2012年7月至2013年11月为9例肝硬化门静脉高压致食道下端静脉曲张患者行完全腹腔镜脾切除联合贲门周围血管离断术。结果：8例手术获得成功,1例因术中大出血中转开腹。手术时间120～360 min,平均（160±12）min;术中出血量200～2 300 ml,平均（450±25）ml。术后发生胸腔积液1例、腹水1例,无死亡病例。术后住院5～20 d,平均（8±2）d。7例患者术后随访3～26个月,平均（12±3）个月,术后再出血1例,余均无再出血。结论：腹腔镜脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症是可行的,具有患者创伤小、康复快等优点。术中解剖细致,分离脾蒂及贲门周围血管时遵循＂先易后难,由浅入深,步步为营＂的原则,切勿图快,一旦出现大出血应果断中转开腹。

Objective：To investigate the surgical skills and clinical applications of laparoscopic splenectomy combined with pericardial.devascularization for cirrhosis and portal hypertension. Methods：From Jul. 2012 to Nov. 2013,9 patients with lower esophageal varices caused by cirrhosis and portal hypertension underwent laparoscopic splenectomy combined with pericardial devascularization. Results： Eight operations were successful, and one case was converted to laparotomy because of intraoperative hemorrhage. The operation time was 120-360 rain, mean （160±12 ） rain. The mean blood loss was （450±25 ） ml （range 200-2 300 ml ）. Postoperative complications included one case of pleural effusion and one ascites. No death occurred. The mean postoperative hospital stay was （ 8 ±2 ） d （ range, 5-20 d）. Seven patients were followed up for 3-26 months, mean （ 12 ± 3 ） months, only one bled again. Conclusions ： Lap- aroscopie splenectomy combined with pericardial devaseularization in the treatment of cirrhosis and portal hypertension is feasible, mini- mally invasive. Patients received this procedure can recover quickly. Surgeon should carefully anatomize during operation, separate splenic pedicle and pericardial vessels following the principle of ＂from easy to difficult, advance gradually and entrench oneself at every step＂, timely convert to open procedure once hemorrhage occurred, and should not operate too quickly.