腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症7例报告

发布时间：2018-01-29 17:19

本文关键词： 腹腔镜脾切除门静脉高压症贲门周围血管离断术　出处：《中国微创外科杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨腹腔镜脾切除联合贲门周围血管离断术(laparoscopic splenectomy and esophagogastric devascularization,LSED)治疗肝硬化门静脉高压症(portal hypertension,PHT)的安全性和可行性。方法我院2015年1月~2016年5月我科完成7例LSED,均在静吸复合麻醉下应用二级脾蒂离断法行LSED。术中超声刀、Liga Sure相结合逐步离断二级脾蒂,完全游离脾脏,离断贲门周围血管至食管下段6~10 cm,分别于脾窝、食管旁放置引流管。术后2个月行钡餐检查。结果 7例均在完全腹腔镜下完成脾切除联合贲门周围血管离断术,手术时间200~325 min,平均250.7 min。术中出血量200~1000 ml,平均421.4 ml。术后胸腔积液合并低热2例、术后脾窝积液合并发热1例,均经非手术治疗治愈。术后排气时间为3~4 d,住院时间9~12 d。7例随访3~17个月,平均10个月,术后2个月钡餐检查示食管胃底静脉曲张较术前明显减轻,均无再出血。结论 LSED治疗PHT安全可行。
[Abstract]:Objective to explore laparoscopic splenectomy combined with pericardial devascularization. Laparoscopic splenectomy and esophagogastric devascularization. LSED was used to treat portal hypertension in cirrhotic portal hypertension. Methods from January 2015 to May 2016, 7 cases of LSED were completed in our hospital. LSE D was performed by using secondary splenic pedicle amputation under intravenous and inhaling combined anesthesia. During the operation, the second splenic pedicle was dissociated completely by ultrasonic scalpel Liga Sure combined with gradual dissection of the secondary splenic pedicle. The blood vessels around the cardia were located in the splenic fossa at 6 ~ 10 cm from the lower esophagus. Barium meal examination was performed 2 months after operation. Results all 7 cases underwent splenectomy and peripheral cardia vascular dissection under complete laparoscopy. The operative time was 200325 min. The mean volume of intraoperative bleeding was 200ml, 421.4 ml. Postoperative pleural effusion combined with hypothermia was found in 2 cases and splenic fossa effusion with fever in 1 case. All cases were cured by non-surgical treatment, the postoperative exhaust time was 3 ~ 4 days, and the hospitalization time was 9 ~ 12 days. 7 cases were followed up for 3 ~ 17 months, with an average of 10 months. Barium meal examination at 2 months after operation showed that esophageal and gastric varices were significantly alleviated and no rebleeding was found in all patients. Conclusion LSED is safe and feasible in the treatment of PHT.
【作者单位】：哈尔滨医科大学附属第一医院肿瘤、腔镜外科;
【基金】：黑龙江省杰出青年科学基金(JC201416) 卫计委资助课题项目(W2014RQ09) 中俄转化医学专项基金(CR201415)
【分类号】：R656
【正文快照】： 肝硬化门静脉高压症(portal hypertension,PHT)近50%患者伴有脾功能亢进和食管胃底静脉曲张[1]。脾切除联合贲门周围血管离断术是治疗PHT的主要手术方式。近年来,腹腔镜手术以创伤小、疼痛轻、恢复快等优点[2]深受外科医生青睐,并逐渐应用于普外科的各个领域。伴随着技术的进

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