腹腔镜脾切除联合贲门周围血管离断术18例体会  

The technique of laparoscopic splenectomy combined with cardiac peripheral vascular disconnection

作　　者：郭辉[1] 陈杰[1] 宋劲松[1] 

机构地区：[1]天门市第一人民医院普外科,湖北天门431700

出　　处：《腹部外科》2016年第3期197-200,共4页Journal of Abdominal Surgery

摘　　要：目的 探讨完全腹腔镜脾切除、贲门周围血管离断术（laparoscopic splenectomy plus pericardial devascularization,LSPD）的技术改进.方法 采用预先结扎脾动脉,建立脾门后隧道,根据脾门具体形态使用Endo-GIA分次离断脾蒂、应用直线切割闭合器离断胃冠状曲张静脉丛（胃蒂）的方法优化LSPD来治疗门静脉高压症及脾功能亢进.结果 18例病人均顺利完成手术,手术时间130～350min,术中出血120～900ml.其中11例病人行选择性贲门周围血管离断术,6例病人行非选择性贲门周围血管离断术,1例病人胃短静脉撕裂出血术中转为开腹手术.术后引流4～5 d,12例病人拔除引流管;术后6～8 d,6例病人拔除引流管.术后病人禁食及胃肠减压24～48 h,26～72 h肛门排气,引流4～8 d,住院及随访期间无死亡病例.术后2例病人出现血小板计数突然升高[（670～820）＆#215;109/L],7例病人出现腹水（550～800ml）,均对症治疗后好转,术后无感染性并发症、结肠损伤等严重并发症,切口愈合良好.18例术后住院时间8～20 d,术后1个月,上消化道钡餐或胃镜复查,8例病人改善为轻度胃底食管静脉曲张,5例病人改善为中度胃底食管静脉曲张,改善效果较为理想;其余5例也较术前减轻.随访8～24个月内,均未见死亡病例,无复发者.结论 改良的LSPD可显著提高全腹腔镜手术成功率,减少术中出血量和缩短手术时间.Objective To probe into the modified technique of laparoscopic splenectomy plus pericardial devascularization （LSPD）. Methods The pre-ligatured splenic artery was applied to con- struct the posterior hilus lienis tunnel; the straight-line or swinging endo-GIA stapler was adopted in accordance with the morphology of the hilus lienis to divide the primary splenic pedicle; and the straight-line endo-GIA stapler was utilized to divide the gastric coronary varicose vein plexus with an aim to optimize LSPD for treating portal hypertension and hypersplenism. Results Eighteen patients were successfully operated on. The operation time was 130-350 min, and intraoperative blood loss was 120 to 900 mL. Eleven cases were subjected to selective pericardiac devascularization, 6 to nonselec- tive pericardiac devascularization, and 1 case of short gastric vein torn bleeding was intraoperatively converted to open operation. The drainage tube was removed at 4th-Sth day in 12 cases and at 6th-8th day in 6 cases after drainage, respectively. Patients were given postoperative fasting and gastrointesti- nal decompression for 24-48 h, and at 26-72 h the anus exhausted. During hospitalization and follow- up periods, there were no deaths. Postoperatively, the amount of platelets were suddenly elevated in 2 cases [-（670-820） × 10^9/L], and the volume of ascites was 550-800 mL in 7 cases. The suddenly ele- vated platelets and ascites were improved after symptomatic treatment. No serious complications such as postoperative infection and colon injuries occurred. Incisions healed well. The hospital stay in 18 cases was 8-20 days. One month postoperation, upper gastrointestinal barium meal or gastroscope re- examination displayed mild stomach esophagus varicosity in 8 cases, and moderate gastric and esopha- geal varices in 5 cases. During a follow-up period of 8 to 24 months, there were no deaths, and no re- currence. Conclusions Optimized LSPD could enhance the success rate of total laparoscopy, reduce a-mount of intra-operative bleed

关 键 词：肝硬化 腹腔镜 门静脉高压症 脾切除术 贲门周围血管离断术 

分 类 号：R657.34[医药卫生—外科学]