摘要
目的探讨完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬变门静脉高压症的手术技巧和临床应用价值。方法对我科2009年3月至2010年8月期间,12例肝硬变门静脉高压症致食管下段胃底静脉曲张患者应用超声刀和血管闭合切割系统(Ligasure),行完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗的临床资料进行回顾性分析与总结。结果 12例均在处理脾蒂前夹闭脾动脉,其中10例完成腹腔镜手术(其中7例应用二级脾蒂离断法处理脾蒂),2例中转开腹。10例腹腔镜手术患者的手术时间为180～300min,平均210min;术中失血200～1 000ml,平均480ml;术后住院时间8～15d,平均9d;术后发生少量(<300ml)胸腔积液2例,少量(<300ml)腹水2例,轻度(<10ml/d)胰瘘1例,均未作特殊处理,带管出院后1个月好转拔管,无死亡病例。12例患者术后平均随访7个月(4～20个月),均未发生再出血。结论用超声刀预夹闭脾动脉,联合应用超声刀和Ligasure进行二级脾蒂离断法处理脾蒂是完全腹腔镜下巨脾切除联合贲门周围血管离断术成功的关键技术要领,该技术安全、有效、微创,具有一定的临床应用价值。
Objective To evaluate the operative technique and clinical efficacy of laparoscopic splenectomy（LS） combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis.Methods Twelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010,which clinical data were analyzed and summarized retrospectively.Results The splenic artery was ligated before the treatment of splenic pedicle in 12 cases,LS combined with pericardial devascularization was successfully performed in 10 cases,7 cases of which were treated by the level two transection method of splenic pedicle,and 2 cases were converted to open surgery due to intraoperative bleeding.In 10 cases,the operative time was 180-300 min（average 210 min）,and intraoperative blood loss was 200-1 000 ml（average 480 ml）.The postoperative hospital stay was 8-15 d（average 9 d）,the postoperative complications included plural effusion（300 ml） in 2 cases,mild ascites（300 ml） in 2 cases,and mild pancreatic leakage in 1 case,but all were cured eventually,and no mortality occurred.Follow-up was conducted in 12 patients for 4 to 20 months（average 7 months）,and no rebleeding occurred.Conclusions LS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis.The keys to success include ligation of splenic artery,and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.
出处
《中国普外基础与临床杂志》
CAS
2011年第11期1205-1208,共4页
Chinese Journal of Bases and Clinics In General Surgery
