“隧道法”腹腔镜脾切断流术  

Tunnel-building laparoscopic splenectomy and pericardial devascularization

作　　者：万赤丹[1] 唐勇[1] 

机构地区：[1]华中科技大学附属协和医院肝胆外科,武汉430022

出　　处：《中华普外科手术学杂志（电子版）》2017年第3期189-189,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要："隧道法"腹腔镜脾切断流手术利用腹腔镜下易于建立隧道的特点,通过自然的解剖间隙,建立多条隧道,安全切除脾脏并进行贲门周围血管离断。术中取头高脚低平卧位、左侧垫高30°、五孔法。首先打开胃结肠韧带,分离结扎脾动脉,建立胰尾后隧道控制脾脏动静脉;经脾蒂上缘间隙建立脾后隧道并结扎脾蒂,切割闭合器整体离断脾蒂;结扎离断胃短血管及脾膈韧带,切除脾脏。束带悬吊胃底,离断胃后血管,显露左侧膈肌脚;离断贲门前方被膜,显露右侧膈肌脚;经"胃蒂"上缘间隙离断"胃蒂";建立食管下段后隧道,逐结扎食管穿支及高位食管支,同时保留食管旁静脉,完成选择性断流。"隧道法"腹腔镜脾切断流手术取得了满意效果,并且简便安全,易于推广。The tunnel-building laparoscopic splenectomy and pericardial devascularization （TLSPD） could be performed safely through multiple tunnels which naturally existed in anatomical space. The patients were performed in the dorsal elevated supine position with 30 degree right lateral by using five-ports method. Firstly, the gastrocolic ligament was dissected, the artery of spleen was separated and ligated, and then the tunnel of pancreatic tail was built to control splenic artery and vein. Subsequently, the second tunnel behind spleen was built through the interspace of superior border of splenic pedicle, and the splenic pedicle was ligated and dissected by using an Endocutter. The short gastric vessels and splenophrenic ligament were dissected respectively and spleen were removed. Furthmore, the posterior gastric vessels were mutilated after the gastric fundus was suspended by using a band, thus revealing the left crura of diaphragm. After mutilating anterior cardiac membrane, the right crura of diaphragm was exposed. The gastric pedicle was mutilated through the superior interspace and the third tunnel behind the lower esophagus was buih. The perforating and high branch vein of esophagus were ligated, while the para-esophageal vein was reserved, thus selective devascularization was completed . The TLSPD is easy and safe, which could obtain satisfactory efficacy and is worth promotion.

关 键 词：腹腔镜 高血压 门静脉 脾切除术 贲门周围血管离断术 

分 类 号：R657.6[医药卫生—外科学]