二级脾蒂解剖在门静脉高压症分流术中的应用  

APPLICATION OF TECHNIQUE OF SPLEEN SUBPEDICLE DISSECTION FOR SPLENECTOMY IN REFORMED SPLENOCAVAL SHUNT IN PORTAL HYPERTENSION PATIENTS

作　　者：杜立学[1,2] 张煜[1,2] 吴武军[1,2] 耿西林[1,2] 刘青光[3] 

机构地区：[1]陕西省西安交通大学医学院第三附属医院 [2]陕西省人民医院,西安710068 [3]陕西省西安交通大学医学院第一附属医院

出　　处：《肝胆外科杂志》2010年第1期31-34,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨二级脾蒂解剖在门静脉高压症脾切除贲门周围血管离断术联合改良脾腔分流术中的应用价值。方法回顾性分析我科1996-2008年147例门静脉高压症脾亢患者采用二级脾蒂解剖脾切除术并施行贲门周围血管离断术改良脾腔分流术的临床资料。结果146例病例成功施行二级脾蒂解剖脾切除术,并顺利完成二级脾蒂血管与下腔静脉的吻合。无1例出现胰尾和胃壁损伤,术后无腹腔出血、切口感染、膈下积液,围手术期无门静脉血栓形成。脾热发生7例（4.76%）,腹水形成16例（10.88%）,肺部感染2例（1.36%）,围手术期无1例死亡。结论二级脾蒂解剖脾脏切除术可有效减少门静脉高压症巨脾手术并发症,也是施行改良脾腔分流术的关键步骤之一。Objective Evaluate the value of technique of spleen subpedicle dissection for splenectomy in combination of reformed splenocaval shunt with portaazygous devascularization in portal hypertension patients.Methods 147 cases′clinical data of portal hypertension and hypersplenism operated with spleen subpedicle dissection for splenectomy in combination of reformed splenocaval shunt with portaazygous devascularization from 1996-2008 were retrospectively analyzed.Results 146 cases were operated successfully with spleen subpedicle dissection for splenectomy,and spleen subpedicle blood vessel were anastomosed with inferior vena cava successfully.No pancreatic cauda or gastric wall injury,no peritoneal cavity hemorrhage,hydrops of below diaphragm or portal vein thrombosis happened postoperatively.No portal vein thrombosis in peroperative period.7 splenic fever cases（4.76%）,16 ascites formation cases（10.88%）,2 pulmonary infection cases（1.36%）,and no death in peroperative period.Conclusion Spleen subpedicle dissection for splenectomy can depress the complications of portal hypertension operation,and it is one of the committed steps in reformed splenocaval shunt.

关 键 词：脾切除 门静脉高压症 脾腔分流术 

分 类 号：R575[医药卫生—消化系统]