“隧道法”腹腔镜脾切除加贲门周围血管离断术治疗门静脉高压症

Tunnel-building laparoscopic splenectomy and pericardial devascularization in the treatment of portal hypertension

目的总结“隧道法”腹腔镜脾切除加贲门周围血管离断术（TLSPD）对门静脉高压及其并发症的治疗效果。方法采取建立隧道的方法完成TLSPD（包括胰尾后隧道、脾后隧道及食管下段后隧道）。收集2014年1月至2017年6月接受TLSPD治疗的患者临床资料及随访资料，统计分析患者的手术时间、术中出血量、是否中转开腹、围手术期并发症等围手术期资料数据以及门静脉血栓发生情况、术后再出血情况等远期随访数据。结果共466例患者接受TLSPD，手术时间为（145．0±55．0）min，术中失血量（60．0±29．0）ml，6例患者中转开腹。466例患者中，20例出现围手术期并发症，发生率4．3％，无围手术期死亡患者。术后随访有214例患者形成门静脉血栓，9例发生上消化道再出血。结论TLSPD是一种安全有效、易于推广的微创术式，能显著降低患者的手术出血风呤。

Objective To evaluate the clinical efficiency of Tunnel-building laparoseopic splenectomy and pericardial devascularization （TLSPD） in the treatment of portal hypertension. Methods The clini- cal data of patients who underwent TLSPD from 2014 Jan to 2017 Jun were retrospectively studied. The oper- ative time, intraoperative blood loss, conversion rate, postoperative complication rate, and the follow-up data analyzed. Result 466 patients underwent surgery successfully. The operative time was （145.0±55.0）min, and the intraoperative blood loss was （60.0±29.0）ml. There were 6 conversions to open surgery. The compli- cation rate was 4.3%. No deaths occurred during the perioperative period. Variceal rebleeding occurred in 9 patients and portal vein thrombosis occurred in 214 patients. Conclusions TLSPD was safe and efficious with a low operative risk. The treatment resulted in a low rate of variceal rebleeding.