保留食管旁静脉腹腔镜选择性贲门周围血管离断术技术要点

目的总结保留食管旁静脉腹腔镜选择性贲门周围血管离断术技术要点。方法回顾分析浙江省人民医院肝胆胰外科2019年1月至2020年3月收治的13例肝硬化门静脉高压症患者临床资料,所有患者均行保留食管旁静脉腹腔镜选择性贲门周围血管离断术,其中男性9例,女性4例,年龄范围41~83岁,中位年龄51岁。分析患者手术时间、术中出血量、术后并发症情况和随访相关资料。结果13例患者均顺利完成手术,无患者中止手术或中转开腹,手术时间(170±32)min,术中出血量(160±30)ml,术后住院时间(6.1±1.1)d,术后无胰漏、腹腔感染等并发症。随访1~15个月,1例发生门静脉血栓,无上消化道再出血情况。结论保留食管旁静脉腹腔镜选择性贲门周围血管离断术是一种精准断流术,需要团队紧密配合和丰富的腹腔镜手术经验医生完成,保留胃冠状静脉的主干和食管旁静脉的完整是关键,手术是安全可行的。

Technical and essential steps in laparoscopic selective devascularization with paraesophageal veins-preservation

Objective To study the technical and essential steps in laparoscopic selective devascularization with paraesophageal veins-preservation.Methods To retrospectively analyze the clinical data of 13 cirrhotic patients who underwent laparoscopic selective pericardial devascularization for portal hypertension at the Department of Hepatobiliary and Pancreatic Surgery,Zhejiang Provincial People's Hospital from January 2019 to March 2020.There were 9 males and 4 females with age ranging from 41 to 83 years(median 51 years).The operative time,intraoperative blood loss,postoperative complications and follow-up data were analyzed.Results All the 13 patients completed theoperation,no patient stopped the operation or transferred to laparotomy.The operation time was(170±32)min.The intraoperative bleeding was(160±30)ml.The postoperative hospital stay was(6.1±1.1)days.There were no complications,including pancreatic leakage and intra-abdominal infection.On follow-up which ranged from 1 to 15 months,one patient developed portal vein thrombosis,no upper gastrointestinal rebleeding.Conclusions Preservation of esophageal veins in laparoscopic selective devascularization is an accurate surgery which requires close teamwork and rich experience in laparoscopic surgery.The preservation of the main trunk of the gastric coronary vein and integrity of the esophageal veins are the keys to the surgery which is safe and feasible.