摘要
目的总结腹腔镜脾切断流术(laparoscopic splenectomy and esophagogastric devascularization,LSED)治疗门静脉高压消化道出血的诊治经验及手术入路。方法选取2018年1月至2020年4月首都医科大学附属北京佑安医院收治的因门静脉高压导致顽固性消化道出血接受LSED治疗的24例患者,分析其临床疗效及手术入路。结果24例患者中有22例(91.7%)应用腹膜后优先解剖入路,术中平均出血量为402.1 ml,术后复查WBC和PLT较术前显著回升(P<0.05),最常见的并发症为腹水(8/24,33.3%)和一过性胰漏(5/24,20.8%),均对症处理痊愈,无二次手术及死亡病例。术后早期、3个月及1年的门静脉血栓形成率分别为4.2%、41.7%和33.3%,术后1年内消化道出血复发率为4.2%。结论LSED治疗门静脉高压消化道出血安全有效,腹膜后优先解剖手术入路可以提供清晰的安全边界,有助于LSED的成功实施。
Objective To summarize the clinical experience and explore the surgical approach of laparoscopic splenectomy and esophagogastric devascularization(LSED)for the esophagogastric varices hemorrhage secondary to portal hypertention.Methods Clinical documents of 24 patients who underwent LSED for intractable esophagogastric varices hemorrhage due to portal hypertension from January 2018 to April 2020 at Beijing Youan Hospital,Capital Medical University were collected.The clinical efficacy and surgical approach of these patients was retrospectively analyzed.Results A prioritized retroperitoneal anatomic approach was applied in 22 of 24 patients(91.7%).The mean intraoperative blood loss was 402.1 ml.The postoperative levels of WBC and PLT were significantly higher than those before operation(P<0.05).The most common postoperative complications were ascites(33.3%)and transient pancreatic leak(20.8%),which were both cured after symptomatic treatment.There were no cases of secondary surgery or death.The portal vein thrombosis rate in the early postoperative period,three-months and one-year were 4.2%,41.7% and 33.3%,respectively,and the recurrence rate of gastrointestinal re-bleeding within one year after surgery was 4.2%.Conclusions LSED for the esophagogastric varices hemorrhage is safe and effective.The prioritized retroperitoneal anatomic surgical approach can provide a clear and safe border for the successful performance of LSED.
作者
张其坤
张振
马超
张海涛
栗光明
王孟龙
Zhang Qikun;Zhang Zhen;Ma Chao;Zhang Haitao;Li Guangming;Wang Menglong(Department of General Surgery Center,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)
出处
《北京医学》
CAS
2022年第6期499-504,共6页
Beijing Medical Journal
关键词
腹腔镜脾切断流术
消化道出血
手术入路
门静脉高压症
laparoscopic splenectomy and esophagogastric devascularization(LSED)
esophagogastric varices hemorrhage
surgical approach
portal hypertention
