腹腔镜下胃左血管及脾动脉主干结扎在重症肝硬化门静脉高压症中的应用

发布时间：2018-12-31 11:28

【摘要】：目的探讨腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝硬化门静脉高压症的临床效果。方法2012年6月~2014年12月我科对26例肝硬化失代偿期门静脉高压上消化道反复出血者,腹腔镜下找到胃左动静脉,根部用大号Hem-o-lok夹闭,于脾动脉近端跳动最明显处,游离出脾动脉约1 cm,用大号Hem-o-lok夹闭。结果 26例手术均成功,手术时间(28.1±6.2)min,出血量(50.5±13.4)ml,术后住院时间10~14 d,平均12 d。26例术后2周复查白细胞(44.5~78.4)×10~9/L,血小板(124.5~338.4)×10~9/L。21例术后3个月复查,ALT正常11例,10例ALT 42.7~63.5 U/L;AST正常10例,11例AST 51.5~63.4 U/L;TBIL正常12例,9例TBIL 22.5~38.4μmol/L;血浆白蛋白正常12例,9例28.4~34.8 g/L。21例术后3个月胃镜提示食管胃底静脉曲张减轻,轻度8例、中度10例、重度3例,红色征阴性,无活动出血,与术前比较明显改善(χ~2=14.472,P=0.001)。围手术期无死亡。21例随访24~60个月,平均36个月,无一例上消化道再次出血发生。结论腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝硬化门静脉高压症安全可行,效果良好,在肝功能ChildPugh分级为C级的患者中值得推广应用。
[Abstract]:Objective to investigate the clinical effect of laparoscopic ligation of left gastric artery and proximal splenic artery in the treatment of severe cirrhosis and portal hypertension. Methods from June 2012 to December 2014, 26 patients with recurrent hemorrhage of upper gastrointestinal tract in decompensated portal hypertension of liver cirrhosis were found under laparoscope. The left gastric arteriovenous vein was located under laparoscope, and the root was clamped with large Hem-o-lok, which was most obvious in the proximal end of splenic artery. Free splenic artery was clamped with large Hem-o-lok for about 1 cm,. Results all the 26 cases were successfully operated. The operative time was (28.1 卤6.2) min, bleeding volume (50.5 卤13.4) ml, postoperative hospitalization time was 10 ~ 14 days, the average of 12 d.26 cases was (44.5 卤78.4) 脳 10 ~ (9) / L white blood cell 2 weeks after operation. Platelet count (124.5% 338.4) 脳 10~9/L.21 was reexamined 3 months after operation. ALT was normal in 11 cases and ALT was 42.7% 63.5 U / L in 10 cases. 10 cases of AST were normal, 11 cases of AST were 51.5 + 63.4 UL / TBIL, 12 cases were normal, 9 cases of TBIL were 22.5 渭 mol/L; and 38.4 渭 mol/L; respectively. Plasma albumin was normal in 12 cases and gastroscopy in 9 cases 3 months after operation showed that esophageal and gastric fundus varices were alleviated, mild 8 cases, moderate 10 cases, severe 3 cases, red sign negative, no active bleeding. There was significant improvement compared with pre-operation (蠂 ~ 2 ~ 2 ~ (14.472) P ~ (0. 001). There was no death in perioperative period. 21 cases were followed up for 24 ~ 60 months (mean 36 months). No rebleeding of upper digestive tract occurred. Conclusion Laparoscopic ligation of left gastric artery and proximal splenic artery is safe and effective in the treatment of severe cirrhosis and portal hypertension. It is worth popularizing in patients with ChildPugh grade C of liver function.
【作者单位】：甘肃省武威肿瘤医院胃肠外科;
【分类号】：R657.3

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