完全腹腔镜下乙肝肝硬化门脉高压性巨脾切除术的临床研究

Clinical study of totally laparoscopic splenectomy for megalosplenia with hepatitis B liver cirrhosis and portal hypertension

目的:探讨腹腔镜下乙肝肝硬化门脉高压性巨脾切除术的临床应用效果及手术技巧。方法:回顾分析2015年9月至2017年6月为17例乙肝肝硬化门脉高压症巨脾患者行腹腔镜脾切除术的临床资料。结果:15例成功完成手术,1例因脾静脉破裂出血止血困难、1例因脾门粘连解剖困难中转开腹。手术时间150～220 min,平均(180.8±17.8) min;术中出血量500～1 500 mL,平均(770.54±156.78) mL,术后淡血性引流液总量10～120 mL,平均(58.6±37.6) mL。术中、术后均无并发症发生。结论:腹腔镜下门脉高压性巨脾切除术出血风险高,技术难度大,对术者腹腔镜下处理出血的技术及心理素质要求极高;但具有患者创伤小、美容效果好、手术并发症少、术后康复快等优点,值得推广应用。

Objective：To explore the clinical eftect and surgical skills of laparoscopic splenectomy for megalosplenia with hepa- titis B liver cin＇hosis and portal hypertension.Methods： Clinical data of 17 megalosplenia patients with hepatitis B liver cirrhosis and portal hypertension who underwent laparoscopic splenectomy ti＇om Sep.2015 to Jun.2017 were retrospectively analyzed.Results：Two pa- tients were converted to traditional open splenectomy because one patient was difficult to stop bleeding with spleen vein tracture, the oth- er was difficult to dissect the spleen pedicle adhesion.The other 15 operations were successtully completed. Operation time was 150- 220 rain with the mean of （ 180.8± 17.8）min.Intraoperative blood loss was 500-1500 mL, mean value was （770.54± 156.78） mL.Total drainage volume of pale bloody fluid was 10-120 mL with the average of （58.6± 37.6 ）mL. No complications occmTed during and after operation.Conclnsions：Laparoscopic splenectomy tot megalosplenia with portal hypertension has high risk of bleeding, operating diffi- culty and very high requirements tot surgeons to deal with bleeding and psychological quality.But it deserves to be recommended in the clinical application because of tew trauma and complications, good cosmetic ettect and tast recovery.