门静脉高压症183例脾切除的治疗体会

目的总结门静脉高压症脾切除的治疗经验。方法回顾性分析我院2006年1月至2009年12月门静脉高压症脾切除的183例患者的临床资料。结果无手术死亡病例,无术后脾蒂血管出血,无胰漏、胃底及结肠损伤等严重并发症。术后主要并发症包括左膈下脓肿1例、肺部感染5例、左侧胸腔积液7例、大量腹水9例、门静脉系统血栓形成21例,均经保守治疗后治愈。结论脾动脉的妥善处理、脾周韧带及粘连的解剖分离、脾蒂血管的正确处理以及脾窝创面的彻底止血是门静脉高压症脾脏切除的关键。

Clinical experience of splenectomy in 183 patients with portal hypertension

Objective To summarize the experience of splenectomy in patients with portal hypertension.Methods From January 2006 to December 2009,the clinical data of 183 cases with splenectomy in patients with portal hypertension were analyzed retrospectively.Results All of 183 cases survived.No cases of operative mortality,splenic pedicle bleeding,pancreatic leakage or gastric and colonic injury existed.The postoperative complications included 1 case with left subphrenic abscess,5 cases with lung infection,7 cases with left pleural effusion,9 cases with massive ascites,and 21 cases with portal vein thrombosis.All complications were cured by conservative treatments.Conclusion Proper treatment of splenic artery,anatomic separation of splenic ligament and adhesion,precise management of splenic pedicles and complete hemostasis of splenic fossa are key points in performing splenectomy in pa-tients with portal hypertension.