全腹腔镜下脾脏切除联合断流术的综合评估与手术技术经验  

Comprehensive evaluation and technical experience of total laparoscopic splenectomy and esophagogastric devascularization on the treatment of patients with portal hypertension

作　　者：鲁建国 阴继凯 王栋 Lu Jianguo;Yin Jikai;Wang Dong(Department of General Surgery,Tangdu Hospital,Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学附属唐都医院普通外科,西安710038

出　　处：《中华肝胆外科杂志》2021年第1期8-11,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金项目(81700533);陕西省重点研发计划(2017SF-116);唐都医院创新发展基金(2017LCYJ003、2018JSYJ010、2019LCYJ005)。

摘　　要：全腹腔镜脾脏切除联合断流术目前已成为外科治疗门静脉高压症的重要手段。与传统开放手术相比,腹腔镜手术具有操作精细、创伤小、患者术后恢复快等显著优势。精准的术前评估、精细的手术操作及精致的围手术期管理仍是腹腔镜门静脉高压症围手术期管理的重要环节。术前合理精准的个体化评估、严格掌握手术适应证及禁忌证是保证患者围手术期安全及手术合理性的重要依据;术中规范化个体化的精细手术操作是精准断流、减少术中出血及降低围手术期并发症的关键;术后加速康复外科理念有利于门静脉高压症患者快速恢复,减少手术相关并发症。抗凝治疗是降低门静脉系统血栓的一种安全有效的治疗方式。加强多学科间协作是未来推动门静脉高压症治疗的重要任务。Total laparoscopic splenectomy combined with pericardial devascularization has become an important surgical treatment for portal hypertension patients.Compared with the traditional open surgery,laparoscopic surgery has multiple advantages including precise operation,small trauma and quick recovery.Accurate preoperative evaluation,precise surgical operation and delicate perioperative management are still important parts in perioperative management of laparoscopic surgery.Preoperative reasonable and accurate individualized assessment,strict control surgical indications and contraindications are the important basis to ensure the perioperative surgery to be safe and rational;standardized and individualized surgical operation is the key for accurate vascular disconnection,reducing intraoperative bleeding and perioperative complications;the concept of fast-track surgery is conducive to the rapid recovery of patients with portal hypertension and reduce the operation related complications.Anticoagulant therapy is a safe and effective treatment to reduce portal vein thrombosis.It is an important task to strengthen the cooperation among different disciplines for the treatment of portal hypertension in the future.

关 键 词：高血压 门静脉 腹腔镜 脾切除术 贲门周围血管离断术 脾功能亢进 

分 类 号：R657.3[医药卫生—外科学]