腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压上消化道出血

Laproscopic Splenectomy and Pericardial Devascularization Treat Portal Hypertension and Upper Gastrointestinal Hemorrhage

从胃大弯侧中部开始向头侧方向切断胃结肠韧带,凝闭切断胃网膜左血管、胃短血管直到胃底和贲门左侧。切断胃胰皱襞,在胰尾部上缘显露并夹闭脾动脉主干。继续凝断脾结肠韧带、脾肾和脾膈韧带,在脾门处显露胰尾,以切割闭合器切断脾蒂,完成脾切除。凝断食管下端和胃近端覆盖的韧带和血管,暴露两侧膈肌脚和膈肌裂孔,切断小弯侧肝胃韧带,向膈肌裂孔内继续切断食管周围高位和异位门体交通支,切断和夹闭胃左和胃右动脉交通支,闭合器切断胃左动、静脉,完成贲门周围血管离断。胃底行内翻折叠缝合。常规取标本,冲洗、止血、放置引流管。

Along the greater curvature, up to the cardia, the gastrocolic ligament, left gastroepiploie vessels, the splenogastric ligament and short gastric vessels were coagulated and cut off. The splenic artery was dissected and clipped on the upper margin of pancreatic tail. Then the splenocolic, splenorenal, and splenophrenic ligaments were ligated. Pancreatic tail was exposed and protected. Splenic pedicle was cut by Endo-GIA stapler. The ligaments covered the lower part of esophagus and proximal stomach and the portal-systemic collateralization vessels including high or ectopic esophageal branches were all sealed and transected. Both sides diagram pars and the diaphragmatic hiatus were exposed clearly. The left gastric artery and vein were also cut by Endo-GIA stapler. The collateral branches between the right and left gastric vessels were clipped. Gastric fundus was repaired with inverted fold suture. Sample fetching, irrigation, hemostasis and drainage were routine procedure.