完全腹腔镜脾切除贲门周围血管离断术121例临床研究

目的探讨全腹腔镜下脾切除贲门周围血管离断术(LSPD)治疗肝硬化门静脉高压症(PH)的可行性、有效性和安全性。 方法回顾分析2014年1月至2017年12月完成的LSPD 121例临床资料。 结果115例顺利完成，6例中转开腹(5.2%)，手术时间95～325 min，平均162 min；术中出血100～1 600 ml，平均285 ml；术后住院时间6～20 d，平均8.6 d。术后腹腔出血3例，2例出血量较大再次开腹手术止血，1例经保守治疗出血控制。术后轻度腹水9例，胸腔积液7例，胰腺假性囊肿1例，肺部感染2例，无围手术期死亡。术后随访3～50个月，门静脉系血栓形成13例(11.3%)，反复腹水4例(3.5%)。消化道再出血4例(3.5%)，1例经胃镜下止血治愈，1例行TIPS出血停止，另2例失血性休克抢救无效死亡。1例术后2年肝功能衰竭死亡。其余患者均生存。 结论LSPD是一种安全、有效的治疗治疗肝硬化PH的微创手术方法。

Total Laparoscopic Splenectomy and Pericardial Devascularization: a Clinical Study of 121 Cases

ObjectiveTo explore the feasibility, effectiveness and safety of total laparoscopic splenectomy and pericardial cardia vascular dissection in the treatment of portal hypertension with cirrhosis. MethodsThe clinical data of 121 cases of total laparoscopic splenectomy and pericardial devascularization performed in our department from January in 2014 to December in 2017 were retrospectively analyzed. Results115 cases were successfully completed by laparoscopic splenectomy and pericardial devascularization, 6 cases were transferred to open surgery, the operation time was 95~325 min, average 162min, the intraoperative hemorrhage was 100~1600 ml, average 285 ml, and postoperative hospitalization time was 6 to 20 d, mean 8.6 d. Postoperative abdominal bleeding occurred in 3 cases, laparotomy was performed to stop bleeding in 2 cases for the massive bleeding, 1 cases were treated by conservative treatment. There were 9 cases of mild ascites, 7 cases of pleural effusion, 1 cases of pancreatic pseudocyst, 2 cases of pulmonary infection, and no perioperative death. After 3~50 months of follow-up, there were 13 cases of portal vein thrombosis, 4 cases of recurrent ascites, 4 cases of alimentary tract rebleeding, among which 1 cases of hemostasis was treated with gastroscope, 1 cases was treated with TIPS, the 2 other cases was died for hemorrhagic shock. And 1 cases was died for liver failure. ConclusionTotal laparoscopic splenectomy and pericardial devascularization is a safe and effective minimally invasive procedure for the treatment of cirrhosis of the portal hypertension.