摘要
目的探讨完全腹腔镜脾切除、贲门周围血管离断术（laparoscopic splenectomy pluspericar dialdevascularization，LSPD）的优化技术。方法应用预先结扎脾动脉，建立脾门后隧道，根据脾门形态应用直线或可转弯切割闭合器分次离断二级脾蒂、应用直线切割闭合器离断胃冠状曲张静脉丛的方法优化LSPD来治疗门静脉高压症及脾功能亢进。结果29例患者手术均顺利完成，1例中转开腹。28例腹腔镜手术时间（207．2±59．3）min，术中出血量（287．7±212）ml，术中输血量（106．7±98．3）m1。术后肛门排气时间（4．6±1．7）d，术后住院时间（11．8±2．9）d。术后并发腹腔感染1例、门静脉血栓形成1例、肝功能衰竭者2例。无胰瘘、腹腔出血、及术后上消化道出血病例。1例死于术后肝功能衰竭，1例术后肝功能衰竭经过人工肝治疗后痊愈。结论优化的LSPD可提高全腹腔镜手术成功率，缩短手术时间和减少术中出血量。
Objective To evaluate a modified totally laparoscopic splenectomy plus pericardial devascularization （LSPD） for the treatment of portal hypertension. Methods We applied the technique of ligating the splenic artery in advance followed by the establishment of a tunnel underneath the splenic hilum and the consecutive transection of secondary splenic pedicles and gastric coronary vein with Endo-GIA during the process of splenectomy. Results Totally laparoscopic procedures were performed successfully in 28 cases. Procedure was converted to open surgery in one case because of uncontrollable splenic bleeding. Of the 28 patients that received the total LSPD, the operation time was （207.2 ± 59. 3 ） min, intraoperative blood loss was （ 287.7 ± 212 ） ml, intraoperative blood transfusion volume was （ 106. 7 ± 98. 3 ） ml, postoperative passing gas time was （ 4. 6 ＋ 1.7 ） d, postoperative hospital stay was （ 11.8 ± 2. 9 ） d. Abdominal infection, postoperative portal vein thrombosis and liver failure were found in 1, 1, 2 cases respectively. There were no pancreatic fistula, intraabdominal hemorrhage, postoperative upper gastrointestinal hemorrhage cases. One patient died of liver failure, the other was cured by artificial liver therapy. Conclusions The technique of modified LSPD could reduce the conversion rate of laparoscopic splenectomy and intraoperative blood loss.
出处
《中华普通外科杂志》
CSCD
北大核心
2014年第3期165-167,共3页
Chinese Journal of General Surgery
