完全腹腔镜下改良Sugiura手术治疗肝炎后肝硬化门静脉高压症7例分析  

Totally laparoscopic modified Sugirua procedure for cirrhotic portal hypertension:an analysis of 7 cases

作　　者：蔡小勇[1] 潘孟[1] 黄玉斌[1] 靳小建[1] 晏益核[1] 陆文奇[1] 刘祖军[1] 雷宇[1] 陈永军[1] 梁丽萍[1] 

机构地区：[1]广西医科大学第一附属医院西院微创外科中心,广西南宁530007

出　　处：《中国实用外科杂志》2011年第12期1114-1116,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨完全腹腔镜下改良Sugiura手术治疗肝炎后肝硬化门静脉高压症的方法、技巧,并对其安全性、可行性及手术效果加以评估。方法对广西医科大学第一附属医院2007-2009年收治的7例诊断为肝炎后肝硬化、脾肿大脾功能亢进并胃底食管下段静脉曲张病人,行完全腹腔镜下改良Sugiura手术,即先行脾切除,然后离断食管下段胃底贲门周围血管,食管下段游离8～10cm后,在贲门上方用吻合器完成食管下段横断吻合。结果全部病例均能在完全腹腔镜下完成手术,无中转开腹。手术时间4.0～8.5h,出血200～2000mL,平均700mL。术后病人恢复顺利,无严重并发症发生,随访1.0～2.5年,血细胞恢复正常,无再出血发生。结论完全腹腔镜下改良Sugiura手术是一个高风险的手术,其主要风险在于行脾切除时极易发生大出血。该手术在具有熟练的腹腔镜手术技巧及配合熟练的团队的医院中开展是安全可行的。该手术手术效果确切,对病人的创伤打击小,术后恢复快,美容效果好。Objective To stmly the methods and skills of totally laparoscopic modified Sugirua procedure for cirrhotic portal hypertension, and evaluate the feasibility, safety and operation effect of the procedure. Methods Seven cases of posthepatitie cirrhosis, splenomegaly, hypersplenism and gastric fundus esophagus varicosity admitted between 2007 and 2009 in the First Affiliated Hospital of Guangxi Medieal University were performed totally laparoscopic modified Sugirua procedure~ The procedure included splenectomy, devascularization and esophageal transection. Results The operation was successihl in all 7 patients. The operating time was 4.0 to 8.5 hours. Mean blood loss was 700 mL. The patients recovered well without any severe complications. All the patients were followed up 1.0--2.5 years with normal blood cells and no rebleeding occurred in the time period. Conclusion Totally laparoscopie modified Sugirua procedure is feasible, safe, minimally invasive and fast restored with excellent cosmetic result. It offers a new alternative for the treatment of portal hypertension, but it should be performed by highly skilled laparoscopic surgeons.

关 键 词：门静脉高压 腹腔镜 脾切除术 断流术 Sugiura手术 

分 类 号：R6[医药卫生—外科学]