手助腹腔镜下门静脉高压症巨脾切除术  

HAND-ASSISTED LAPAROSCOPIC SPLENECTOMY FOR PATIENTS WITH PROTAL HYPERTENSION AND HUGE SPLEEN

作　　者：许瑞云[1] 邱万寿[1] 邓美海[1] 汪壮流[1] 刘波[1] 凌云彪[1] 汤照峰[1] 杨柳[1] 

机构地区：[1]中山医科大学附属第三医院普外科,广州510630

出　　处：《中国内镜杂志》2001年第5期47-49,共3页China Journal of Endoscopy

摘　　要：目的 :总结在手助腹腔镜下施行门静脉高压症巨脾切除术的手术方法和经验教训。方法 :患者取平仰卧位。经腹白线作长 6～ 8cm的手助小切口。先经此切口在直视下离断部分脾结肠韧带和脾胃韧带 ,并结扎脾动脉。切口安装自制的充气式切口开关。脐下和左上腹部适当部位安置 3个 10mm(或 12mm)Trocar。切脾方法有两种 ,一是先离断脾周所有韧带 ,待脾蒂完全游离后再以Endo -GIA切断 (方法A) ;二是在直视手术的基础上 ,先以Endo -GIA切断脾蒂 ,后将脾肾韧带、皮膈韧带、剩余的脾胃韧带和胃短血管离断 (方法B)。自 2 0 0 0年 3～ 12月 ,先后对 5例乙肝后肝硬化门静脉高压症患者施行了此种手术。手术时间 12 5～ 180min ,平均 149min。术中失血 70～ 46 0ml,平均 2 2 2ml。采用方法A的 3例术后恢复均顺利 ,未发生任何并发症。采用方法B的 2例均发生胰尾损伤。结论 :手助腹腔镜下门静脉高压症巨脾切除术在技术上是可行的 ,创伤比开腹手术小。但由于此类病人凝血机制差 ,术中避免胰尾损伤至关重要。采用上述方法A可能较为稳妥。不过因例数少 。Objective:To research the operative technique and experiences of Cherio-assisted Laparoscopic Splenectomy for patients with portal hypertension and hunge spleen. Method:After general asesthesia,the atient is placed on operation talbe in a horizotntal position.A 6～8cm long midline incision is then made into the upper abdomen.As a first step,the distal part of gastrosplenic ligament and Colosplenic ligament is respected and the splenic artery is ligated,with use of ordinary operative instruments under direct vision,via the minilaparotomy incision.the second,the incision is fixed with self-made Air-Charging Switch, by which the left hand can be inserted into abdominal cavity to assist the operation as well was ordinary laparoscopic manipulation can be performed when it is closed.Then,a carbon dioxide pneumoperitoneum is created and the three 10mm (or 12mm) trocar canculas are inserted into the left upper side of the abdomen.The third,the proximal part of gastrosplenic ligament with short gastric vessels,the phrenicoplenic ligament and splenorenal ligament,which are too remote for manual manipulation,are resected with laparoscopic instruments.The fourth,the spleen stalk is resected endo-GIA.which is named method A if is done after all other stpeps described above,or named method B if done before the third step.Form March 2000 to dectember 2000,Five patients with cirrhosis of liver and portal hypertension caused by hepatitis B underwent the operation.The method A was applied to three cases,and the method B two.Results:The maximun volume of spleens was 24cm×18cm×10cm,the minimum 19cm×14×cm10cm。The operation time varied from 125 minutes to 180 minutes (the average was 149 minutes).During the operations,blood loss changed from 70ml to 460ml(the average 222ml).The patients with method A (3 cases)all recovered successfully.But the patients with method B (2 cases)both had injury of tail of pancreas.The one was resulted in immediate bleeding,which was stopped by suture ligature under di

关 键 词：腹腔镜 肝硬化 高血压 门静脉 脾切除术 

分 类 号：R657.34[医药卫生—外科学] R657.6[医药卫生—临床医学]