腹腔镜贲门周围血管离断术(脾部分切除)应用价值的初步分析  

Preliminary analysis of the feasibility and value of laparoscopic pericardial devascularization (partial splenectomy) for portal hypertension

作　　者：秦峰 张占国 张磊[1] 项帅 张必翔[1] 刘飞龙 张万广[1] Qin Feng;Zhang Zhanguo;Zhang Lei;Xiang Shuai;Zhang Bixiang;Liu Feilong;Zhang Wanguang(Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techology, Hubei Wuhan 430030, China;Department of General Surgery, Taikang Tongji(Wuhan) Hospital, Hubei Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,湖北武汉430030 [2]泰康同济(武汉)医院普外科,湖北武汉430000

出　　处：《腹部外科》2019年第4期295-299,共5页Journal of Abdominal Surgery

摘　　要：目的初步分析腹腔镜贲门周围血管离断术(脾部分切除)治疗肝硬化门静脉高压症的临床价值。方法收集2017年3月至2019年2月华中科技大学同济医学院附属同济医院6例腹腔镜贲门周围血管离断术(脾部分切除)病人临床资料并进行分析。结果6例病人均顺利完成了腹腔镜贲门周围血管离断术(脾部分切除),手术时间为(327±68)min,术中出血量为(447±147)ml。术后拔管时间为(7±2)d,胃肠功能恢复时间为(2.5±0.5)d,住院时间为(9±2)d。术后5例脾功能亢进消失,1例较前缓解。复查胃镜均提示食管胃底静脉曲张程度较前减轻。术后1例发生门静脉血栓,1例发生胸腔积液,1例出现发热,无出血、胰漏、腹腔感染、肝性脑病等并发症。结论腹腔镜贲门周围血管离断术(脾部分切除)治疗肝硬化门静脉高压症初步分析效果较满意。Objective To analysis the value of laparoscopic pericardial devascularization (partial splenectomy) in the treatment for liver cirrhosis with portal hypertension. Methods The clinical data of 6 patients who underwent laparoscopic pericardial devascularization (partial splenectomy) in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from March 2017 to February 2019 were collected and analyzed. Results Laparoscopic pericardial devascularization (partial splenectomy) was successfully performed in 6 patients, with mean operation time of (327± 68) min and intraoperative blood loss of (447±147) ml. The postoperative extubation time was (7±2) d. The postoperative gastrointestinal function recovery time was (2.5±0.5) d , and the postoperative hospital stay was (9±2) d.Postoperative hypersplenism disappeared in 5 cases and relieved in 1 case. Repeated gastroscopy after surgery showed that the degree of esophageal and gastric varices were relieved. Postoperative complications included portal vein thrombosis in 1 case, pleural effusion in 1 case, and fever in 1 case. There were no complications such as bleeding, pancreatic leakage, abdominal infection and hepatic encephalopathy. Conclusion Laparoscopic pericardial devascularization (partial splenectomy) is an effective method for the treatment of cirrhotic portal hypertension.

关 键 词：腹腔镜 脾部分切除术 贲门周围血管离断术 门静脉高压症 

分 类 号：R657.3[医药卫生—外科学]