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

Laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension

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可行性及安全性。方法：2012年6月至2015年6月为35例肝硬化门脉高压症合并食管胃底静脉曲张患者行腹腔镜脾切除联合贲门周围血管离断术。结果：31例完全腹腔镜手术成功,4例因术中出血难以控制立即中转开腹。手术时间190~330 min,平均（260±30）min;术中出血量250~1 600 ml,平均（350±50）ml。术后予以护肝、利尿、输白蛋白、血浆等对症治疗。住院7~21 d,平均（10±3）d。除1例患者因术后肝功能衰竭放弃治疗外,余均治愈出院。随访1个月~2年,3例患者因门脉高压性胃病再次出血,经保守治疗后治愈,其余患者无再次上消化道出血。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安全、有效、可行,行断流手术时,脾切除后操作空间更大,视野更加开阔,贲门周围血管离断更加方便,虽然手术时间可能较长,但具有对机体影响小、术后康复快、住院时间短等微创优势。

Objective： To explore the feasibility and safety of laparoscopic splenectomy and pericardial devascularization in treating cirrhosis with portal hypertension. Methods： From Jun. 2012 to Jun. 2015,35 patients who had cirrhosis with portal hypertension as well as esophagogastric varices underwent laparoscopic splenectomy combined with pericardial devascularization. Results： The procedures were successful in 31 cases. 4 patients were converted to laparotomy because the bleeding was not under control. The mean operation time was（ 260 ± 30） min（ range 190 to 330 min）. The mean intraoperative blood loss was（ 350 ± 50） ml（ range 250 to1 600 ml）. After operations,symptomatic treatments were carried out with the help of protecting their livers,diuretic therapy,transfusing albumin or plasma. The mean hospital stay was（ 10 ± 3） d（ range 7 to 21 d）. All the patients were cured except one who had hepatic failure. The patients were followed up for 1-24 months. 3 patients developed rebleeding due to portal hypertensive gastropathy and were cured after conservative therapy. The other patients did not suffer from gastrointestinal bleeding. Conclusions： Laparoscopic splenectomy combined with pericardial devascularization is safe,feasible and effective in treating cirrhosis with portal hypertension. During the devascularization operation,the operative space after splenectomy is larger with wider view and more convenient pericardial devascularization.Although the operative time is longer,this procedure has minimally invasive advantages such as little influence on body,quick postoperative recovery and short hospital stay.