腹腔镜下脾切除联合选择性贲门周围血管离断术

目的探讨腹腔镜下脾切除联合选择性贲门周围血管离断术(laparoscopic splenectomy combined with selectivepericardial devascularization,LSPD)治疗门脉高压症(portal hypertension,PHT)的安全性、可行性及操作技巧。方法回顾性分析2011年3月～2012年3月连续15例因PHT行腹腔镜下脾切除联合LSPD的围手术期资料。观察手术时间、术中出血量、术后排气时间、术后并发症发生率及术后住院时间并随访。结果 15例均顺利完成手术,无中转开腹。术中发现副脾2例。手术时间150～340 min,中位数230 min。术中出血量80～1600 ml,中位数450 ml。腹腔引流管留置时间3～8 d,中位数5 d。术后住院时间7～15 d,中位数10 d。无出血、胰漏等手术并发症。15例随访3～12个月,均存活,2例发生便血。结论LSPD治疗PHT安全、可行。

Total Laparoscopic Splenectomy Combined with Selective Pericardial Devascularization for Portal Hypertension

Objective To evaluate the feasibility, safety and the surgical skills of total laparoseopic splenectomy combined with selective pericardial devascularization （LSPD） in the treatment of portal hypertension （PHT）. Methods Perioperative data of 15 patients with PHT, who received LSPD in our hospital from March 2011 to March 2012, were analyzed retrospectively. The operation time, intraoperative blood loss, and postoperative recovery time of gastrointestinal function, complications, and hospital stay were observed. Results The procedure was completed in all the 15 patients without conversion to open surgery. Accessory spleen was detected in two of the patients during the procedure. The median operation time of this series was 230 rain （ ranged from 150 to 340 min）, and median intraoperative blood loss was 450 ml （80 - 1600 ml）. After the operation, intra-abdominal drainage tube was removed in 3 to 8 days （median, 5 days） , and the patients was discharged from hospital in 7 to 15 days （median, 10 days）. No patient had hemorrhage, pancreatic leakage, or other surgical complications. The 15 patients were followed up for 3 to 12 months, all of them survived, and two of them showed hemafecia during the period. Conclusions LSPD is safe and feasible for patients with PHT. We recommend routine use of this procedure.