腹腔镜脾切除贲门周围血管离断术治疗肝硬化门脉高压症合并脾功能亢进技巧总结  

Laparoscopic splenectomy combined with pericardial devascularization for patients of cirrhosis with portal hypertension and hypersplenism

作　　者：姚宁 方旭东 曹宗权 朱郭增 方晓明 YAO Ning;FANG Xudong;CAO Zogquan;ZHU Guozeng;FANG Xiaoming(Department of general surgery,903rd Hospital of PLA,Zhejianghangzhou 310013,China;96811 army health team,Zhejiangquzhou 324109,China)

机构地区：[1]解放军第903医院普通外科,浙江杭州310013 [2]96811部队卫生队,浙江衢州324109

出　　处：《现代仪器与医疗》2019年第6期35-37,共3页Modern Instruments & Medical Treatment

摘　　要：目的:探讨腹腔镜下脾切除贲门周围血管离断术在治疗肝硬化门脉高压症合并脾功能亢进中的手术技巧。方法:回顾分析2010年5月至2018年6月行腹腔镜脾切除贲门周围血管离断术的33例患者临床资料。结果:本组30例完成腹腔镜下手术,手术时间160~300min,平均225min。术中出血100~1200mL,平均350mL。术后腹腔引流放置3~14天,平均4.6天。术后发生胸腔积液3例,左膈下感染1例,腹水量增多4例,均经对症治疗后好转或治愈。术后住院5~18天,平均8.7天,无死亡病例。术后随访3~36个月,2例患者术后再出现上消化道出血,分别在术后9、17个月,经内科治疗后治愈。结论:腹腔镜下脾切除并贲门周围血管离断术在技术上安全可行,创伤小,恢复快,疗效满意。Objectives:To discuss the technique of laparoscopic splenectomy combined with pericardial devascularization for the treatment of cirrhotic portal hyrertension.Methods:The clinical data of 33 cases underwent laparoscopic splenectomy combined with pericardial devascularization from May 2010 to June 2018 were analyzed retrospectively.Results:The operation was completed successfully in the 30 cases.The mean operation time was 225 min(range,160-300 min).The mean intraoperative blood loss was 350 mL(range,100-1200mL).The mean time of abdominal drainage was 4.6 days(range,3-14 days).After the operation,2 patients developed plural effusion,1 had subphrenic infection,4 had mild ascites,all these patients were cured by respective treatment.The mean hospitalization was 8.7days(range 5-18 days).No mortality occured.All the patients were followed up for 3-36 months.Two patients developed rebleeding after the operatin.Conclusion:Laparoscopic splenectomy combined with pericardial devascularization is not only feasible and safe but also has the merits of minimally invasive surgery for the treatment of cirrhotic portal hyrertension.

关 键 词：腹腔镜 脾切除术 门奇断流术 门脉高压症 

分 类 号：R657.3[医药卫生—外科学]