腹腔镜断流术处理门静脉高压症临床研究

目的 探讨腹腔镜脾切除和断流术的手术方法、安全性和有效性.方法 从2000年1月至2007年4月为30例肝硬化门静脉高压症、继发性脾功能亢进和上消化道出血的病人进行了腹腔镜脾切除和门奇静脉断流术,其中2例于上腹部作小切口,再行管型吻合器完成食管下段横断再吻合术,3例完全腹腔镜下应用腔内管型吻合器行食管下段横断和吻合术.结果 该组30例病人手术均获成功.无1例中转开腹手术,手术时间4～5.5 h,出血量60～400 ml,术后24 h～5 d肛门恢复排气,无严重并发症发生,术后住院8～15 d,平均12 d.术后1个月复查食管吞钡显示食管曲张静脉较术前明显减轻.随访22例1个月至4年,脾功能亢进基本纠正、无肝性脑病、未再发生呕血或黑便.结论 腹腔镜脾切除和门奇静脉断流术是安全、有效的,为临床处理门静脉高压症和上消化道出血提供了一种新的治疗选择.

Treatment of portal hypertension with laparoscopic azygoportal disconnection

Objective To evaluate the safety and effectiveness of laparoscopic splenectomy and azygoportal disconnection.Methods From January 2000 to April 2007, 30 patients with cirrhosis and portal hypertension, secondary hypersplenism, and bleeding from the upper alimentary tract were op-erated with laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach in our hospital.For 30 patients, 2 were firstly operated with a small accessory incision, then the lower esophagus was transected and reanastromosed with a circular stapler, and 3 were operated entirely un-der laparoscopy to complete the transaction and reanastomosation of the lower esophagus with a circu-lar stapler.Results Operation on the 30 patients were successful without a single conversion from laparoscopic to open surgery.The operative duration varied from 4 to 5.5 hours, and the bleeding vol-ume were between 60 to 400 ml.The fart was resumed between 24 to 96 hours after operation.There were no serous complications.The duration of hospitalization was 8-15 days (mean= 12 days).The up GI X-ray examination revealed that esophageal variees was significantly attenuated 1 month after surgery.The follow-up in twenty-two patients for 1 month to 4 years after surgery indicated that hy-persplenism was virtually corrected, no hepatic encephalopathy was found, and no hematemesis and melena occurred.Conclusion Laparoscopic splenectomy and devasclarization of the lower esophagus and upper stomach are safe and effective, providing a new alternative choice to treat portal hyperten-sion and bleeding from the upper digestive tract.