腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症的临床研究

A clinical study of laparoscopic splenectomy and pericardial devascularization for portal hypertension

目的:探讨腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症的可行性、安全性及有效性。方法:回顾分析2016年1月至2018年5月为12例患者行腹腔镜脾切除联合贲门周围血管离断术的临床资料。结果:12例均成功完成腹腔镜脾切除联合贲门周围血管离断术,手术时间平均(241.5±39.8)min,术中出血量平均(407.5±73.0)mL,术后平均住院(8.6±3.8)d。术后发生腹腔出血1例,经介入治疗后腹腔出血停止;发生腹水5例、胸腔积液3例、肺部感染1例、门静脉血栓形成1例,无围手术期死亡病例。术后随访10~30个月,脾功能亢进均得到纠正,3例钡餐示轻度食管胃底静脉曲张,9例钡餐未见异常,均未再发生上消化道出血。结论:腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症是安全、可行的,效果确切。

Objective:To explore the feasibility,safety and effectiveness of laparoscopic splenectomy and pericardial devascularization(LSPD) for portal hypertension.Methods:The clinical data of 12 cases of LSPD performed from Jan.2016 to May 2018 were retrospectively analyzed.Results:All 12 operations were successfully completed under laparoscope,the mean operation time was(241.5±39.8)min,the mean intraoperative blood loss was(407.5±73.0)mL,and the mean postoperative hospitalization time was(8.6±3.8)d.Postoperative abdominal bleeding occurred in 1 case,and was cured after interventional treatment.There were 5 cases of ascites,3 cases of pleural effusion,1 case of pulmonary infection,1 case of portal vein thrombosis,and no perioperative death.After follow-up of 10-30 months,all patients’ hypersplenism improved without symptoms of haematemesis and melena,and barium meal showed 3 cases suffered from slight esophageal and gastric varices,the rest of the patients remained normal.Conclusions:LSPD is a safe,feasible and effective procedure for the treatment of portal hypertension.