完全腹腔镜下脾切除联合贲门周围血管离断术治疗门脉高压症

Laparoscopic Splenectomy and Pericardial Devascularization for Portal Hypertension

目的探讨腹腔镜脾切除联合贲门周围血管离断术的可行性、安全性及有效性。方法 2008年3月-2014年6月,采用完全腹腔镜方法,对45例肝硬化门脉高压并上消化道出血和脾功能亢进的患者行贲门周围血管离断术。术中采用一级脾蒂离断法或者二级脾蒂离断法切脾,断流方法采用选择性或非选择性贲门周围血管离断术。结果 45例在全腔镜下完成（其中28例为选择性贲门周围血管离断术）,其中1例需手助。手术时间110-430 min,平均150 min。术中失血80-1200 ml,平均325 ml。1例术后肝功能衰竭死亡。44例术后住院8-20 d,平均10.6 d。41例术后随访3-60个月,平均36个月,3例再出血,2例原发性肝癌。结论严格把握手术适应证,腹腔镜脾切除联合贲门周围血管离断术安全可行。

Objective To investigate the feasibility,safety,and effectiveness of laparoscopic splenectomy and pericardial devascularization. Methods From March 2008 to June 2014,45 patients with cirrhotic portal hypertension complicated with upper gastrointestinal bleeding and hypersplenism received selective or non-selective pericardial devascularization under laparoscopy in our hospital. Primary or secondary structures of the splenic pedicle were cut for splenectomy during the operation. Results The laparoscopic pericardial devascularization was successfully performed in all the 45 patients（ the paraesophageal vessels were reserved in28 of them）. Hand-assisted procedure was required in 1 case. The mean operation time was 150 min（ range,110-430 min）. The mean intraoperative blood loss was 325 ml（ range,80-1200 ml）. One case of postoperative mortality occurred because of liver failure. The patients were discharged from hospital in 8-20 days after the operation（ mean,10. 6 days）. After that,41 patients received follow-up observations for a mean of 36 months（ range,3-60 months）. During the follow-up,three patients showed hemorrhage and two patients developed primary hepatocellular carcinoma. Conclusion Laparoscopic splenectomy and perieardial devascularization is feasible and effective on the condition that patients are properly selected.