内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术

目的总结腹腔镜下内结扎法巨脾切除联合选择性贲门周围血管离断术的经验。方法采用丝线结扎结合超声刀或LigaSure，进行腹腔镜巨脾切除和选择性贲门周围血管离断术治疗门静脉高压症并发食管胃底静脉曲张6例。结果6例手术全部镜下顺利完成，术中出血量80-200ml，平均130ml，无输血，无中转开腹，手术时间150-210min平均190min。无并发症，术后5天恢复正常活动。术后随访3—10个月，平均8个月，无再发出血。结论应用内结扎法腹腔镜巨脾切除联合选择性贲门周围血管离断术治疗门静脉高压症安全有效，出血少，微创。

Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique

Objective To summarize the experience of laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique. Methods By using silk ligature and hamonic scapel or the LigaSure, 6 patients with portal hypertension and esophagogastric varices underwent laparoscopic massive splenectomy and selective pericardial devascularization. Results All the operations were completed successfully under laparoscope. The intraoperative blood loss was 80~200 ml (mean, 130 ml). None of the patients required blood transfusion or conversion to open procedure. The operation time was 150~210 min (mean, 190 min). There were no surgical complications. All the patients resumed to normal activities 5 days after operation. Follow-up observations for 3~10 months (mean, 8 months) revealed no recurrent variceal hemorrhage. Conclusions Laparoscopic massive splenectomy combined with selective pericardial devascularization using endoligature technique is a feasible, effective, safe, little hemorrhagic, and minimally invasive procedure for portal hypertension with esophagogastric varices.