改良四步法腹腔镜巨脾切除联合贲门周围血管离断术临床效果研究  

Clinical research of the “modified four-step” technique applied in laparoscopic splenectomy and pericardial devascularization

作　　者：洪徳飞 成剑[1] 张宇华[1] 吴伟顶[1] 张成武[1] 谢志杰[1] 刘杰[1] 沈国樑[1] 

机构地区：[1]浙江省人民医院肝胆胰外科及微创外科,浙江杭州310014

出　　处：《中国实用外科杂志》2016年第11期1193-1196,共4页Chinese Journal of Practical Surgery

摘　　要：目的总结改良四步法用于腹腔镜巨脾切除联合贲门周围血管离断术（LSPD）的疗效和经验。方法回顾性分析2012年6月至2015年6月浙江省人民医院肝胆胰外科及微创外科采用改良四步法行LSPD的105例病人的临床资料。结果105例病人均完成手术，其中2例（1．9％）中转开放手术，余103例在腹腔镜下顺利完成。手术时间为（175．6±49．8）min，术中出血（310．9±240．9）mL。术后发生腹腔出血1例，胰瘘1例，腹腔感染2例，脾静脉血栓2例，肝功能不全3例。1例肝功能不全进展出现肝性脑病放弃治疗自动出院，其余病人通过保守治疗均治愈出院。术后住院时间为（8．7±3．6）d。术后随访12-48个月，2例分别在术后3月余、术后1年再发上消化道出血，经急诊内镜发现1例为食管中上段静脉曲张伴出血，1例为胃窦及胃体广泛糜烂伴出血。结论采用改良四步法行LSPD成功率高，术后并发症发生率低，病人术后恢复快，且中长期随访出血复发率低，值得临床推广应用。Objective To summarize effect and experience of the ＂modified four-step＂ technique applied in laparoscopic splenectomy and pericardial devascularization （LSPD）. Methods The clinical data of 105 cases of LSPD conducted by the ＂ modified four-step＂ technique between June 2012 and June 2015 in Department of Hepatobiliary Pancreatic and Micro-invasive Surgery, Zhejiang Provincial People＇ s Hospital were analyzed retrospectively. Results All cases were operated successfully. Among them, 2 cases （1.9%） were converted to open surgery and the rest 103 cases were conducted successfully under complete laparoscopy. Operative time was （175.6 ± 49.8） min and blood loss was （310.9 ± 240.9） mL. Postoperative complication included 1 case of abdominal bleeding, 1 case of pancreatic leakage, 2 cases of abdominal infection, 2 cases of splenic vein thrombosis, 3 cases of hepatic dysfunction. One case of liver dysfunction with hepatic encephalopathy gave up treatment and automatically discharged. Other cases were cured by conservative treatment. Postoperative hospital stay （8.7 ± 3.6）d. Two cases ocurred recurrece of GI bleeding after following 12-48 months. Conclusion The ＂modified four-step＂ technique in LSPD has high laparoscopic success rate, low rate of postoperative complications and the low rate of GI bleeding recurrence. It＇s worthy of clinical promotion and application.

关 键 词：腹腔镜 肝硬化 门静脉高压症 脾切除 责门周围血管离断术 

分 类 号：R6[医药卫生—外科学]