腹腔镜脾切除加贲门周围血管离断术治疗门静脉高压症的疗效评价  

Clinical experience of laparoscopic splenectomy and pericardial devascularization on the treatment of portal hypertension

作　　者：唐勇[1] 王文静[1] 张宇[1] 施申超[1] 胡青钢[1] 万赤丹[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《中华普通外科杂志》2016年第2期93-96,共4页Chinese Journal of General Surgery

摘　　要：目的 探讨腹腔镜脾切除加贲门周围血管离断术（laparoscopic splenectomy and pericardial devascularization,LSPD）的手术技巧,并评价其临床疗效.方法 我们对腹腔镜脾切除加断流术进行了整体改良,术中解剖“脾蒂上缘间隙”和“胃蒂上缘间隙”,采用“两间隙两隧道法”进行手术操作,并收集2013年6月至2015年3月采用“两间隙两隧道法”手术方式完成LSPD 189例患者的临床资料,分析手术时间、术中出血量、中转开腹率,术后住院时间等指标,评价近期治疗效果.结果 本组189例LSPD中包括34例腹腔镜下巨脾切除术和21例腹腔镜下重度食管胃底静脉曲张断流术.平均手术时间为（125±52） min,术中平均失血量（58±32） ml,中转开腹手术4例,术后平均住院时间为（7.5±2.1）d.结论 术中通过建立“脾蒂上缘间隙”和“胃蒂上缘间隙”,采用“两间隙两隧道法”整体离断“脾蒂”和“胃蒂”可以降低手术难度和出血风险,是一种安全、简便的手术方式,可作为巨脾和严重食管胃底静脉曲张的常规治疗手段.Objective To investigate the operational technique of laparoscopic splenectomy and pericardial devascularization （LSPD） and evaluate the clinical efficiency of this method for the treatment of portal hypertension.Methods With the new understanding of anatomical space around the spleen,the cardia and the fundus,two gaps and two tunnels can be created in LSPD.Retrospective analysis was made on the clinical data of patients who underwent LSPD from Jun 2013 to Mar 2015.The operative time,intraoperative blood loss,postoperative hospital stay,conversion rate and postoperative complication rate were measured.Results A total of 189 cases underwent surgery successfully,including 34 cases of splenomegaly and 21 cases of severe esophageal varices.The operative time was （125 ± 52） min,intraoperative blood loss （58 ± 32） ml,postoperative hospital stay （7.5-2.1） d.There were 4 conversion cases in this study.Conclusions The splenic pedicle and stomach pedicle can be safely dissected with the ＂two gaps and two tunnels＂ principle,which makes LSPD safe and convenient.

关 键 词：高血压 门静脉 脾切除术 腹腔镜 贲门周围血管离断术 

分 类 号：R657.34[医药卫生—外科学]