腹腔镜下门静脉高压症巨脾切除的手术技巧和风险评估（附九例报告）

目的探讨腹腔镜下门静脉高压症巨脾切除的手术技巧及手术风险评估。方法回顾性分析2011年6月至2011年10月实施腹腔镜下门静脉高压症巨脾切除手术9例的临床资料。结果本组成功施行全腹腔镜下手术6例，因出血中转开腹手术3例，手术中转率33．3％。无手术并发症发生，无死亡病例。结论腹腔镜下门静脉高压症巨脾切除病人术前要根据影像学检查进行评估，严格把握腹腔镜手术适应证，脾蒂的处理是全腹腔镜下手术成功的关键，术中大出血是腔镜手术失败中转开腹的主要原因。术中谨慎、耐心的操作，果断的判断中转手术时机对于确保病人安全最为重要。尽管风险很大，只要掌握好关键技术，腹腔镜下门静脉高压症脾切除还是安全、可行的。

Surgical technique and risk assessment for laparoscopic splenectomy of portal hypertension:A report of 9 cases

Objective To study the surgical technique and risk assessment of laparoscopic splenectomy for portal hypertension. Methods The clinical data of 9 cases of portal hypertension undergoing laparoscopic splenectomy from June 2011 to Oct. 2011 were retrospectively analyzed. Results Laparoscopic splenectomy was performed on 6 cases, and 3 cases were converted to open surgery （33. 3 ~）. There were no operative complications and no deaths. Conclusion The patients with portal hypertension undergoing laparoscopic splenectomy should be assessed preoperatively according to the imaging. The laparoscopic surgical indications should be strictly held. Treatment of splenic pedicle is key to the success of endoscopic surgery. Intraoperative bleeding is the main reason of conversion of endoscopic surgery to open surgery. Despite risky, laparoscopic splenectomy for patients with portal hypertension is safe and feasible.