摘要
目的总结二级脾蒂离断法在完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的临床经验。方法2005年3月至2005年10月间,对15例肝硬化门静脉高压致食管下端静脉曲张患者行完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗,其中13例应用二级脾蒂离断法处理脾蒂切除脾脏。结果13例在完全腹腔镜下成功应用二级脾蒂离断法巨脾切除联合贲门周围血管离断术,无1例中转开腹。手术时间(232±47)min,术中失血(480±232)ml。全组均于术后24-72 h内恢复胃肠蠕动,术后第1天下床活动,术后住院时间6-14 d,平均8．7 d。术后发生胸腔积液3例,左膈下脓肿1例,B超引导穿刺治愈。无死亡病例。结论在完全腹腔镜下巨脾切除联合贲门周围血管离断术中,应用二级脾蒂离断法不仅安全可行,而且节省费用,具有较大的临床推广价值。
Objective To evaluate the technique of separate control of the splenic artery and vein in laparoscopic splenectomy （LS） and pericardial devascularization in the treatment of portal hypertension. Methods From March 2005 to October 2005 thirteen cases with cirrhotic portal hypertension underwent LS and paraesophagogastric devascularization. The splenic pedicles were all managed by separate control of the splenic artery and vein branches laparoscopically, Results Laparoscopic procedure was all successful in the 13 cases. The mean operative time was （232 ±47） mins （range 180 mins to 320 mins ）, intraoperaive estimated blood loss was （480± 232） ml （range 200 ml to 800 ml）. All patients were treated with plasma transfusion, antibiotics, and abdominal drainage postoperatively. Alimentary tract function recovered 24 hours to 48 hours after operation. The mean postoperative hospital stay was 8.7 days （range 6 to 14 days）. Postoperative complications included plural effusion in 3 cases and subphrenic abscess in one case. No mortality occurred. Conclusions The technique of separate control of the splenic artery and vein in laparoscopic splenectomy （LS） and pericardial devascularization in the treatment of portal hypertension is feasible, safe and effective.
出处
《中华普通外科杂志》
CSCD
北大核心
2006年第10期706-708,共3页
Chinese Journal of General Surgery
