六步法腹腔镜脾脏切除联合贲门周围血管离断术治疗门静脉高压症的应用体会

Application of six-step laparoscopic splenectomy combined with pericardial devascularization for portal hypertension

目的:探讨六步法腹腔镜脾脏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临床效果。方法:回顾分析2016年1月至2019年3月采用六步法腹腔镜脾脏切除联合贲门周围血管离断术治疗的46例肝硬化门脉高压症患者的临床资料。结果:44例顺利完成腹腔镜手术,2例中转开腹,其中1例为寻找脾动脉造成严重出血,1例为术后脾窝有活动性出血,腔镜下无法满意止血;合并肝癌4例,术中同时行超声引导下经皮肝癌射频消融术;合并胃间质瘤1例,一并切除。手术时间平均(160.6±42.8)min,术中出血量平均(320.9±150.2)mL。术后发生脾静脉血栓12例,门静脉血栓4例,无胰瘘、腹腔感染、肝功能衰竭、胃瘫等严重并发症发生。腹腔引流管拔除时间平均(5.6±1.2)d,术后平均住院(9.7±3.2)d。术后2个月因门静脉系统广泛血栓形成死亡1例。结论:六步法腹腔镜脾切除联合贲门周围血管离断术是治疗肝硬化门静脉高压症安全、有效的术式,值得推广应用。

Objective:To explore the clinical efficacy of six-step laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic portal hypertension.Methods:The retrospective study was adopted.The clinical data of 46 patients who underwent six-step laparoscopic splenectomy combined with pericardial devascularization in the department of hepatobiliary and pancreatic surgery from Jan.2016 to Mar.2019 were enrolled.Surgical and therapeutic information was recorded.Results:Among the 46 patients,44 cases were successfully completed by laparoscopic surgery,2 cases were converted to open surgery(1 case had severe hemorrhage due to searching for splenic artery;1 case had active hemorrhage in the splenic fossa after operation and endoscopic hemostasis was unsatisfactory).4 cases combined with hepatocellular carcinoma underwent percutaneous radiofrequency ablation guided by color Doppler ultrasound.1 case combined with gastric stromal tumor was resected.The mean operative time was(160.6±42.8)min,and the intraoperative estimated blood loss was(320.9±150.2)mL.Postoperative complications included splenic venous thrombosis in 12 cases and portal vein thrombosis in 4 cases.No pancreatic fistula,abdominal infection,liver failure or gastroparesis occurred.The abdominal drainage tubes were removed in average of(5.6±1.2)d,and the mean postoperative hospital stay was(9.7±3.2)d.1 case died of extensive portal venous thrombosis 2 months after operation.Conclusions:Six-step laparoscopic splenectomy combined with pericardial devascularization is safe,feasible and effective in the treatment of portal hypertension.