手助腹腔镜脾切除联合贲门周围血管离断术治疗门脉高压症

目的:探讨手助腹腔镜脾切除联合贲门周围血管离断术治疗门脉高压症的手术方法及技巧。方法:2009年7月至2011年12月为26例肝硬化门脉高压患者行手助腹腔镜脾切除联合贲门周围血管离断术。结果:26例均顺利完成手助腹腔镜手术,手术时间167～237 min,平均187 min;术中出血量467～1 820 ml,平均510 ml;术后住院7～16 d,平均9.7 d;术后无死亡病例及严重并发症发生。结论:手助腹腔镜脾切除术联合贲门周围血管离断术治疗门脉高压症安全、微创、可行,明显降低了复杂腹腔镜手术的难度及风险,手术成功的关键是防止术中大出血。

Hand-assisted laparoscopic splenectomy combined with pericardial devascularization for portal hypertension

Objective:To investigate the techniques of hand-assisted laparoscopic splenectomy combined with pericardial devascularization for portal hypertension.Methods:Twenty-six patients with portal hypertension were operated by hand-assisted laparoscopic splenectomy combined with pericardial devascularization from Jul.2009 to Dec.2011.Results:The operations were completed successfully.The mean operation time was 187(167-210) min,the blood loss was 510(467-1 820) ml,the mean postoperative hospital stay was 9.7(7-16) days.All patients had recovered rapidly and no serious complications or death occurred.Conclusions:Hand-assisted laparoscopic splenectomy combined with pericardial devascularization for portal hypertension is safe and feasible,and has the merits of minimally invasive surgery.This procedure obviously decreases the difficulty of complex laparoscopy,the key of operative success is prevention of intraoperative hemorrhea.