原位脾切除联合选择性贲门周围血管离断术治疗门静脉高压症  

Orthotopic spelenectomy and selective pericardial devascularization for portal hypertension

作　　者：张晓君[1] 周敏[1] 张军[1] 姜新春[1] 张昕辉[1] 

机构地区：[1]徐州市中心医院(南京中医药大学徐州中西医结合临床医学院)肝胆胰脾外科,江苏省221009

出　　处：《中华普通外科杂志》2016年第10期801-803,共3页Chinese Journal of General Surgery

摘　　要：目的 分析原位脾切除联合选择性贲门周围血管离断术治疗门静脉高压症的疗效.方法 在保持脾脏原位状态下紧贴脾脏离断脾周韧带及胃短血管,最后离断脾蒂.在贲门周围血管离断时采用紧贴胃和食管的选择性血管离断术式,保留迷走神经前后干.结果 手术治疗63例门静脉高压症患者,术前自由门静脉压力为（38±4） cmH2O,术后降至（28±4）cmH2O.平均手术时间为（232 ±15） min,平均手术出血量为（530±37） ml,无手术死亡,术后近期无胰漏、胃排空障碍及门静脉血栓形成等并发症.随访12 ～36个月,无再出血及肝昏迷患者.术后6个月内发生门静脉血栓4例.结论 采用三贴近法进行原位脾切除联合选择性贲门周围血管离断术操作简单,术后能有效降低门静脉压力.Objective To evaluate orthotopic splenectomy and pericardial devascularization for the treatment of portal hypertension.Methods The modified anterior approach splenectomy includes dissection of the peri-splenic vessels and ligments before division of short gastric vessels.During pericardial devascularization,the dessection panel was close to the esophagus and the stomach,leaving intact both the anterior and posterior vagus trunks.Results 63 patients underwent this modified operation.The free portal pressure decreased from （38 ±4） cmH2O to（28 ±4）cmH2O.The average blood loss was （530 ± 37）ml.There was no mortality,nor perioperative gastric paralysis and portal venous thrombosis.By 12-36 months follow-up,there was no pancreatic leakage,hepatic coma and recurrence of bleeding.Intrahepatic portal venous thromboses were detected in 4 cases at the sixth postoperative months.Conclusions This modified splenectomy plus selective pericardial devascularization carries less bleeding and is safe and effective for the treatment of portal hypertension.

关 键 词：高血压 门静脉 脾切除术 选择性贲门周围血管离断术 

分 类 号：R657.34[医药卫生—外科学]