中国实用外科杂志

中国实用外科杂志

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腹腔镜下脾切除加贲门周围血管离断术联合术中胃镜治疗门静脉高压37例分析

唐    勇，朱    锐，赵    龙，王文静，张    宇，刘    尧，万赤丹   

  1. 华中科技大学同济医学院附属协和医院肝胆外科，湖北武汉 430022
  • 出版日期:2015-02-01 发布日期:2015-01-23

  • Online:2015-02-01 Published:2015-01-23

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摘要：

目的    探讨腹腔镜下脾切除加贲门周围血管离断术（LSPD）联合术中胃镜治疗门静脉高压的临床效果。方法    回顾性分析2011年1月至2013年7月华中科技大学同济医学院附属协和医院肝胆外科收治的37例行LSPD联合术中胃镜治疗肝硬化门静脉高压并上消化道出血的病人的临床资料，分析术中出血量、手术时间、住院时间和术后并发症发生率。 结果    36例在腹腔镜下完成，1例因胃底静脉瘤破裂出血中转开腹。术毕胃镜检查23例存在残余曲张食管静脉，均行曲张静脉套扎；2例存在胃底曲张静脉，行组织胶注射。手术时间180~450 min，平均（265.2±42.5）min。术中失血100~850 mL，平均（342.0±146.5）mL。术后发生胸腔积液10例，门静脉血栓l例；难治性腹水l例，无术中及围手术期死亡。术后住院5~11 d，平均（6.5 ±2.0）d。随访3～29个月，6例失访，31例获得随访，无再出血发生。结论    LSPD是一种安全、微创、可行的手术方式，联合术中胃镜可减少术后近期再出血。

关键词: 腹腔镜, 脾切除术, 贲门周围血管离断术, 门静脉高压症, 胃镜

Abstract:

Laparoscopic splenectomy and pericardial devascularization combined with intraoperative endoscopy for treatment of portal hypertension        TANG Yong，ZHU Rui，ZHAO Long，et al. Department of Hepatobiliary Surgery，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430022，China
Corresponding author：WAN Chi-dan，E-mail：chidanwanjsr@163.com
Abstract    Objective    To explore clinical effects of the full laparoscopic splenectomy and pericardial devascularization（LSPD）combined with intraoperative endoscopy for portal hypertension. Methods    The clinical data of 37 cases of portal hypertension with upper gastrointestinal bleeding underwent LSPD combined with intraoperative endoscopy between January 2011 and July 2013 in Department of Hepatobiliary Surgery，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology were analyzed retrospectively. The data included the blood loss，operation time，hospitalization time and postoperative complication rate. Results    Among 36 cases of laparoscopic completed in full，and 1 case converted to open surgery for gastric varices bleeding. After surgery，23 cases of residual varicose esophageal veins were found by intraoperative endoscopy and underwent varicose vein ligation lines. Two cases existed varices and underwent tissue glue injection. Operative time：180-450 min，（265.2±42.5） min on average. Intraoperative blood loss：100-850 mL，（342.0±146.5）mL on average. There were 10 cases of postoperative pleural effusion，l case of portal vein thrombosis，l case of refractory ascites and no intraoperative and perioperative mortality. Postoperative hospitalization time was 5-11 days，(6.5±2.0) days on average. A total of 31 cases were followed up for 3 to 29 months. Sixe cases were lost to follow up. No further bleeding occurred during the follow-up. Conclusion    LSPD is a safe，minimally invasive，feasible surgical approach，which combined with intraoperative endoscopy could reduce postoperative rebleeding.

Key words: laparoscope surgery, splenectomy, cardia peripheral vascular amputation, portal hypertension, endoscopy