腹腔镜脾切除联合选择性贲门周围血管离断术的临床疗效  

Clinical efficacy of laparoscopic splenectomy combined with selective pericardial devascularization

作　　者：张海文 蔺广荣 徐怀勇[1] 成丕光[1] 宋德坤[1] 王建强[1] ZHANG Hai-wen;LIN Guang-rong;XU Huai-yong(Department of General Surgery,Binzhou People’s Hospital,Shandong First Medical University,Binzhou 256600,China)

机构地区：[1]山东第一医科大学附属滨州市人民医院普通外科,山东滨州256600

出　　处：《腹腔镜外科杂志》2022年第6期415-418,共4页Journal of Laparoscopic Surgery

摘　　要：目的:总结腹腔镜脾切除联合选择性贲门周围血管离断术治疗脾功能亢进、门静脉高压症的临床疗效及相关经验。方法:回顾分析2018年7月至2021年7月采用腹腔镜脾切除联合选择性贲门周围血管离断术治疗22例肝硬化门静脉高压症患者的临床资料。结果:22例患者均在腹腔镜下完成手术,无中转开腹。手术时间平均(277±45)min,术中出血量(827±688)mL。术后出现门静脉系统血栓4例,食管瘘1例,胸腔积液1例。无严重并发症发生及死亡病例,患者均康复出院。术后随访2~4个月,门诊复查肝功能均维持在Child A级,无消化道再出血发生。结论:腹腔镜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疗效确切,成功率高,近期疗效满意,值得临床推广。Objective:To summarize the clinical efficacy and relevant experience of laparoscopic splenectomy combined with selective pericardial devascularization for hypersplenism and portal hypertension.Methods:From Jul.2018 to Jul.2021,the clinical data of 22 patients with cirrhotic portal hypertension treated by laparoscopic splenectomy combined with selective pericardial devascularization were retrospectively analyzed.Results:Laparoscopic surgery was performed successfully in 22 patients without conversion to open surgery.The operation time was(277±45)min,intraoperative blood loss was(827±688)mL.The portal vein system thrombosis was found in 4 patients,esophageal fistula was found in 1 patient and pleural effusion in 1 patient.There were no serious complications or deaths,and the patients recovered well and were discharged from hospital.The patients were followed up for 2-4 months.The liver function maintained at Child A level in outpatient reexamination,and there was no rebleeding of digestive tract.Conclusions:Laparoscopic splenectomy combined with selective pericardial devascularization in the treatment of cirrhotic portal hypertension has definite curative effect,high success rate and satisfactory short-term curative effect,it is worthy of clinical promotion.

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

分 类 号：R657.6[医药卫生—外科学]