腹腔镜辅助下微出血实施选择性贲门周围血管离断术

The Laparoscopic Assisted Selective Pericardia Devascularization with Minor Bleeding

目的总结微出血安全实施腹腔镜下选择性贲门周围血管离断术经验体会。方法回顾性总结2008年1月至2014年1月间作者实施上述手术的48例患者的临床资料,包括具体安全措施、手术方法、手术时间和术后并发症以及后期恢复、随访情况。结果 48例患者腔镜手术顺利,无中转开腹。手术时间90~180 min,平均(136.56±27.02)min,手术出血20~50 ml,平均(30.41±8.12)ml。术后7例出现并发症或合并症,发生率为14.58%(7/48):3例肺部并发症,2例血栓性门静脉炎,1例左膈下脓肿,1例胰漏。48例患者均获得2年以上随访观察,术后4~8周血小板趋于稳定,略高于正常水平。术后半年胃底静脉曲张明显减轻,手术后2年38例无明显曲张,余轻微曲张。随访期间无一例呕血、便血,无死亡病例。结论根据患者具体情况,充分评估,规范腔镜手术操作,选用精准切割闭合器,一次性离断同时闭合脾蒂和贲门周围血管,可在腔镜辅助下微出血实施选择性贲门周围血管离断术。

Objective To summarize the experiences of the laparoscopic assisted selective pericardia devascularization with minor bleeding. Methods There were 48 cases enrolled in this study during January2008 to January 2014. All cases received laparoscopic assisted selective pericardia devascularization with minor bleeding. The clinical data were collected including safety managements,operative methods,operating time,postoperative complication,and follow-up results. Results All operative procedures were done successfully and smoothly without any conversion to open operation. The operating time was 90 ~ 180 min（136.56±27.02 min）,the operative blood loss was 20 ~ 50 ml（30.41±8.12 ml）. There were 7 cases occurred operative complications,including 3 cases with pulmonary complications,2 cases with pylethrombophlebitis,1 case with subphrenic abscess,and 1 case with pancreas leakage. All cases were followed up for at least 2 years. The pericardia varicosity gradually returned to palliation,or even disappeared. There was no death or recurrence during the followed-up period. Conclusion It is an effective procedure of the laparoscopic assisted selective pericardia devascularization with minor bleeding,but the following is important when the operations are carried out,such as full assessments,standard endoscopic techniques,suitable selections of the precision cutting closure devices,and one-time closure of the splenic and pericardia vessels.