腹腔镜巨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近期疗效评价  

Laparoscopic splenectomy plus selective pericardial devascularization for the treatment of portal hypertension

作　　者：王蒙[1] 杜晓宏[1] 张海文[1] 张平[1] 吕国悦[1] 王广义[1] Wang Meng;Du Xiaohong;Zhang Haiwen;Zhang Ping;Lyu Guoyue;Wang Guangyi(Department of Hepatobiliary and Pancreatic Surgery,First Hospital,Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院肝胆胰外一科,长春130021

出　　处：《中华普通外科杂志》2018年第7期552-555,共4页Chinese Journal of General Surgery

摘　　要：目的总结腹腔镜巨脾切除联合选择性贲门周围血管离断术治疗肝硬化门静脉高压症的疗效和可行性。方法回顾性分析2015年1月至2017年1月吉林大学第一医院采用腹腔镜巨脾切除联合选择性贲门周围血管离断术治疗肝硬化门静脉高压症29例患者的临床资料。结果本组29例患者均完成手术，其中1例中转开放手术，其余28例在腹腔镜下顺利完成手术，平均手术时间为（235±54）min,平均术中出血（384±262）ml。术后出现脾热1例，脾静脉血栓2例，无腹腔出血、胰瘘及腹腔感染等严重并发症，患者均痊愈出院，术后平均住院时间为（9．6±1．9）d。随访3～6个月，3例发生门静脉血栓，肝功能均维持良好，无消化道再出血、肝性脑病发生。结论腹腔镜巨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成功率高，近期疗效满意。Objective To summarize the efficacy and feasibility of laparoscopic splenectomy combined with selective pericardial devascularization for cirrhotic portal hypertension. Methods From January 2015 to January 2017, the clinical data of 29 cases of cirrhotic portal hypertension treated by laparoscopic splenectomy combined with selective pericardial devascularization were analyzed retrospectively. Results Laparoscopic surgery was successful in all but one cases, who was converted to open surgery. The operation time was （235 -54 ） rain, intraoperative blood loss was （384±262 ） ml. The spleen fever syndrome and splenic vein thrombosis were found in 1, 2 patients respectively after operation. No serious complications of abdominal hemorrhage, pancreatic fistula and intra-abdominal infection were found. The postoperative hospital stay was （9.6±1.9） d, patients were followed up for 3 -6 months, and 3 cases had portal vein thrombosis. The liver function was well maintained. Conclusion Laparoscopic splenectomy combined with selective pericardial devascularization for treatment of portal hypertension is with high success rate and lower incidence of postoperative complications.

关 键 词：高血压 门静脉 脾切除术 腹腔镜 贲门周围血管离断术 

分 类 号：R657.34[医药卫生—外科学]