腹腔镜脾动脉结扎联合贲门周围血管离断治疗肝硬化门静脉高压

目的探讨腹腔镜脾动脉结扎联合贲门周围血管离断治疗肝硬化门静脉高压的安全性及有效性。方法回顾性分析自2014年2月~2018年2月48例腹腔镜脾动脉结扎联合贲门周围血管离断术治疗肝硬化门静脉高压的临床资料。46例保守治疗止血成功后择期手术(Child-Pugh A级30例,Child-Pugh B级16例),内镜及药物止血失败行急诊手术2例(Child-Pugh C级)。结果48例均顺利实施完全腹腔镜手术。手术时间(104.7±4.2)min,术中出血量(106.0±16.4)ml。术中输血1例(2.1%)。无死亡,无术后输红细胞。术后住院时间(5.6±0.2)d。术后随访15~63个月,中位数42个月。1例(2.1%)术后34、47个月因门静脉高压性胃病黑便2次,保守治疗。其他患者均无呕血、黑便。结论在熟练掌握腹腔镜技术的基础上,腹腔镜脾动脉结扎联合贲门周围血管离断术治疗肝硬化门静脉高压安全、有效。

Laparoscopic Pericardial Devascularization Combined With Splenic Artery Ligation for Cirrhotic Portal Hypertension

Objective To estimate the safety and efficiency of laparoscopic pericardial devascularization combined with splenic artery ligation for cirrhotic portal hypertension.Methods We retrospectively analyzed 48 patients with cirrhotic portal hypertension undergoing laparoscopic pericardial devascularization combined with splenic artery ligation in our hospital from February 2014 to February 2018.Selective surgery was performed after conservative hemostasis in 46 patients(Child-Pugh A for 30 cases,Child-Pugh B for 16 cases)and emergency surgery was performed after failure of conservative treatment in 2 patients(Child-Pugh C).Results All the 48 patients underwent laparoscopic pericardial devascularization combined with splenic artery ligation successfully.The mean operative time was(104.7±4.2)min and the mean estimated blood loss was(106.0±16.4)ml.Only 1 patient(2.1%)had intraoperative blood transfusion requirement.No patients died or required blood transfusion after surgery.The mean hospital stay was(5.6±0.2)days.The follow-up time varied from 15 months to 63 months(median,42 months).As of May 2019,only 1 patient(2.1%)had two times of melena due to portal hypertension gastropathy at 34 months and 47 months after surgery and recovered after conservative treatment.Other patients in this study did not have any complications such as haematemesis and melena.Conclusion Laparoscopic pericardial devascularization combined with splenic artery ligation is safe and feasible based on massive experience of laparoscopic technique.