经脐单孔腹腔镜下二级脾蒂离断法行脾切除并胃底贲门周围血管离断术治疗肝炎后肝硬变门静脉高压症的临床应用  

The Two Level of Splenic Pedicle Umbilical Single Hole Laparoscopic Splenectomy and Disconnection Method,Gastric Devascularization in Posthepatitic Cirrhosis and Portal Hypertension Clinical Application

作　　者：孔庆宇[1] 宫金伟 李志强[1] 石景鹏 赵明星[1] KONG Qing-yu;GONG Jin-wei;LI Zhi-qiang;SHI Jing-peng;ZHAO Ming-xing(Department of general surgery, the Fourth Affiliated Hospital of Harbin Medical University, Suihua Heilongjiang 150001)

机构地区：[1]绥化市第一医院普外科,黑龙江绥化152000

出　　处：《世界最新医学信息文摘》2018年第9期21-23,26,共4页World Latest Medicine Information Electronic Version

摘　　要：目的探讨采用经脐单孔腹腔镜下二级脾蒂离断法行脾切除并胃底贲门周围血管离断术治疗肝炎后肝硬变门静脉高压症的临床应用价值。方法回顾性分析2012年6月至2013年8月期间我科实施18例经脐单孔腹腔镜及21例三孔腹腔镜下二级脾蒂离断法行脾切除并胃底贲门周围血管离断术治疗肝炎后肝硬变门静脉高压症患者的临床资料,分别对2组患者术中及术后情况进行比较。结果 (1)单孔腹腔镜组有16例成功完成该项手术,2例在单手辅助腹腔镜下成功完成手术,无中转开腹;三孔腹腔镜组所有患者均成功完成手术。(2)2组术后并发症(食管瘘和腹水)发生率比较,差异均无统计学意义(P>0.05),单孔腹腔镜组有1例术后发生食管瘘给予胃肠减压和留置空肠营养管15 d后患者恢复,有3例术后发生少量腹水,三孔腹腔镜组有4例术后发生少量腹水,对腹水均未作特殊处理,保持引流通畅并于术后3-5d拔出引流管。(3)单孔腹腔镜组的手术时间长于三孔腹腔镜组,2组比较差异有统计学意义(P<0.05);在术后镇痛时间、术后排气时间及住院时间方面均明显短于三孔腹腔镜组,2组比较差异有统计学意义(P<0.05);2组患者的术中出血量比较差异无统计学意义(P>0.05)。(4)2组患者术后均康复出院,术后随访2~13个月,无再出血发生。门诊复查血常规均正常,复查胃镜未见明显食管或胃底静脉曲张。结论对于脾长<30cm的肝炎后肝硬变门静脉高压症患者行经脐单孔腹腔镜下二级脾蒂离断法行脾切除并胃底贲门周围血管离断术在腹腔镜技术经验丰富的团队中开展安全性、可行,具有创伤小、术后疼痛轻、恢复快、切口微小、美容效果好等优点。Objective To investigate the transumbilical single hole laparoscopic two splenic stalk cutting splenectomy,gastric devascularization in posthepatitic cirrhosis and portal hypertension clinical application value. Methods Retrospective analysis of 2012 June to 2013 August in our department 18 cases of transumbilical single port Laparoscopic splenectomy and 21 cases of grade two hole laparoscopic splenic stalk cutting splenectomy,gastric devascularization in hepatitis cirrhosis,clinical data of patients with portal hypertension,respectively,on a detailed assessment of patients in the two group and the situation after operation.Results Single hole laparoscopic group： There are 16 cases of successful completion of the surgery,two cases in a single hand-assisted laparoscopic surgery is completed successfully,without laparotomy. Three hole laparoscopic group：All patients were successfully completed the operation.Hole laparoscopic group one case of postoperative indwelling esophageal fistula give decompression and jejunal feeding tube 15 days after the patient recovered; After a small amount of ascites in 3, 4 cases were three hole laparoscopic group began a small amount of ascites not special treatment,maintain the drainage unblocked and pull out the tube for 3 to 5 days postoperatively. Single hole laparoscopic group in the operation time is slightly longer than the three port laparoscopic group, there was statistically significantdifference between the two groups（P〈0.05）; On postoperative analgesia, postoperative exhaust time and discharged time significantly shorter than three holes on the laparoscopic group, compare the differences between groups was statistically significant（P〈0.05）; Two groups of patients in the intraoperative blood loss and postoperative complications comparing differences between groups have no statistical significance（P〉0.05）. Both groups of patients with postoperative rehabilitation hospital discharge,postoperative follow-up of 2-13 months,no bleeding occurred again. Outp

关 键 词：肝硬变 门静脉高压症 脾功能亢进 单孔腹腔镜脾切除术 三孔腹腔镜 二级脾蒂 

分 类 号：R657.6[医药卫生—外科学]