Abstract:

Clinical research of the “modified four-step” technique applied in laparoscopic splenectomy and pericardial devascularization        HONG De-fei，CHENG Jian，ZHANG Yu-hua，et al. Department of Hepatobiliary Pancreatic and Micro-invasive Surgery，Zhejiang Provincial People’s Hospital，Hangzhou 310014，China
Corresponding author: HONG De-fei, E-mail: hongdefi@163.com
Abstract    Objective    To summarize effect and experience of the "modified four-step" technique applied in laparoscopic splenectomy and pericardial devascularization (LSPD). Methods    The clinical data of 105 cases of LSPD conducted by the " modified four-step" technique between June 2012 and June 2015 in Department of Hepatobiliary Pancreatic and Micro-invasive Surgery，Zhejiang Provincial People’s Hospital were analyzed retrospectively. Results All cases were operated successfully. Among them, 2 cases (1.9%) were converted to open surgery and the rest 103 cases were conducted successfully under complete laparoscopy. Operative time was (175.6 ± 49.8) min and blood loss was (310.9 ± 240.9) mL. Postoperative complication included 1 case of abdominal bleeding，1 case of pancreatic leakage，2 cases of abdominal infection，2 cases of splenic vein thrombosis，3 cases of hepatic dysfunction. One case of liver dysfunction with hepatic encephalopathy gave up treatment and automatically discharged. Other cases were cured by conservative treatment. Postoperative hospital stay (8.7 ± 3.6)d. Two cases ocurred recurrece of GI bleeding after following 12—48 months. Conclusion    The "modified four-step" technique in LSPD has high laparoscopic success rate，low rate of postoperative complications and the low rate of GI bleeding recurrence. It’s worthy of clinical promotion and application.

Key words: laparoscopy, liver cirrhosis, portal hypertension, splenectomy, pericardial devascularization

摘要：

目的    总结改良四步法用于腹腔镜巨脾切除联合贲门周围血管离断术（LSPD）的疗效和经验。方法    回顾性分析2012年6月至2015年6月浙江省人民医院肝胆胰外科及微创外科采用改良四步法行LSPD的105例病人的临床资料。结果    105例病人均完成手术，其中2例（1.9%）中转开放手术，余103例在腹腔镜下顺利完成。手术时间为（175.6±49.8）min，术中出血（310.9±240.9）mL。术后发生腹腔出血1例，胰瘘1例，腹腔感染2例，脾静脉血栓2例，肝功能不全3例。1例肝功能不全进展出现肝性脑病放弃治疗自动出院，其余病人通过保守治疗均治愈出院。术后住院时间为（8.7±3.6）d 。术后随访12～48个月，2例分别在术后3月余、术后1年再发上消化道出血，经急诊内镜发现1例为食管中上段静脉曲张伴出血，1例为胃窦及胃体广泛糜烂伴出血。结论    采用改良四步法行LSPD成功率高，术后并发症发生率低，病人术后恢复快，且中长期随访出血复发率低，值得临床推广应用。

关键词: 腹腔镜, 肝硬化, 门静脉高压症, 脾切除, 贲门周围血管离断术