手助腹腔镜门脉高压症的脾切除和门奇静脉断流术

目的 探讨手助腹腔镜脾切除门奇断流术的手术技术。方法 用手助腹腔镜完成18例脾切除门奇断流术。结果 18例手术全部成功。手术时间150～260min，平均180min。术中出血200～2000mL，平均540mL。切除脾重500～2000g，平均910g。住院时间8～18d，平均9．7d。术后病人恢复顺利，疼痛少，5例术后用止痛剂，24～74h排气，平均52h。手助切口愈合良好，1例出现并发症，1例术后因肝功能衰竭死亡。结论 手助腹腔镜行脾切除门奇断流术不但安全可行，而且具有微创手术的优点，疗效满意。

Hand-assisted laparoscopic splenectomy plus portozygos disconnection procedure for patients with portal hypertension

[Objective] To explore the techniques of hand-assisted laparoscopic splenectomy plus portozygos disconnection procedure. [Methods] 18 patients with portal hypertension were operated by hand-assisted laparoscopic splenectomy plus portozygos disconnection. [Results] The operations were completed successfully. The mean operative time was 180(150~260) minutes, the mean blood loss estimated was 540(200~2 000) mL, the mean weight of spleen was 910 (500~2000) g and the mean length of hospital stay was 9.7 (8~18) days after operation. All patients had recovered rapidly and suffered less pain and only 5 patients needed analgesic. The mean recovery time of the bowel function was 52(24~74) hours. The hand incisions healed well, and only one occurred complications and another suffered death. [Conclusions] Hand-assisted laparoscopic splenectomy plus portozygos disconnection procedure is to be feasible and safe, and has the merits of minimally invasive surgery.