腹腔镜下脾切除、选择性贲门周围血管离断术临床应用实践  

Clinical Application Practice of Laparoscopic Splenectomy and Selective Percardiac Angiomy

作　　者：胡仁健 秦红军 支春平 魏来 郭凯 陈杰 Hu Renjian;Qin Hongjun;Zhi Chunping(Department of Hepatobiliary Pancreas and Spleen Surgery,Leshan Hospital of Traditional Chinese Medicine,Leshan,Sichuan 614000,China)

机构地区：[1]乐山市中医医院肝胆胰脾外科,四川乐山614000

出　　处：《四川医学》2022年第6期578-583,共6页Sichuan Medical Journal

摘　　要：目的探讨腹腔镜下脾切除、选择性贲门周围血管离断术在治疗肝硬化门静脉高压患者的临床应用、并发症发生原因及处理对策。方法回顾分析2014年10月至2021年6月我科106例乙型或丙型病毒性肝炎肝硬化门静脉高压行腹腔镜下脾切除、选择性贲门周围血管离断术的临床资料。结果105例患者在完全腹腔镜下顺利完成手术,1例术中放置蓝蝶在手辅助下切除脾脏。手术时间126~308 min,平均(138±15)min,术中出血50~750 ml,平均(125±20)ml。胃管均在24 h后拔除。24~48 h后肛门排气,平均(35±6)h。术后第4~7 d拔除腹腔引流管,平均(4±1)d。7例出现胃排空障碍,9例出现Ia~Ib级PVST,7例出现左侧反应性胸水,1例出现乳糜漏,经治疗后临床治愈出院。结论腹腔镜下脾切除、选择性贲门周围血管离断术治疗肝硬化门静脉高压是安全、可行,其并发症的预防、治疗也有较好手段。Objective To explore the clinical application,complications and countermeasures of laparoscopic splenectomy and selective percardiac angiomy in the treatment of cirrhosis portal hypertension.Methods The clinical data of 106 cases of hepatitis B or C cirrhosis with portal hypertension in our department from October 2014 to June 2021 were retrospectively analyzed.Laparoscopic splenectomy and selective pericardial devascularization were performed.Results 105 patients successfully completed the operation under complete laparoscopy,and 1 case had Randy placement during the operation and the spleen was removed with hand assistance.The operation time was 126~308 min,with an average(138±15)minutes,and intraoperative bleeding was 50~750 ml,with an average(125±20)ml.The gastric tubes were pulled out after 24 hours.Anus exhausted at 24~48 hours,average(35±6)h.After the operation,the abdominal drainage tubes were removed from the 4~7 d,with an average(4±1)d.7 cases showed gastric emptying disorder,9 cases showed Ia-Ib level PVST,7 cases showed reactive left pleural effusion,and 1 case showed chylous leakage,which was clinically cured and discharged after treatment.Conclusion Laparoscopic splenectomy and selective percardiac angiomy are safe and feasible to treat cirrhosis portal hypertension,and also good methods for the prevention and treatment of complications.

关 键 词：门静脉高压症 脾切除术 选择性贲门周围血管离断术 并发症 

分 类 号：R657.34[医药卫生—外科学]