[1]洪德飞,郑雪咏,严力锋,等.免切割闭合器完全腹腔镜巨脾切除联合贲门周围血管离断术[J].中国微创外科杂志,2008,08(1):21-23.
　Hong Defei,Zheng Xueyong,Yan Lifeng,et al.Laparoscopic Splenectomy without Using EndoGIA Combined with Pericardial Devascularization[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):21-23.
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免切割闭合器完全腹腔镜巨脾切除联合贲门周围血管离断术()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
21-23
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Laparoscopic Splenectomy without Using EndoGIA Combined with Pericardial Devascularization
作者:
洪德飞; 郑雪咏; 严力锋; 王钊; 沈波; 彭淑牖
浙江大学医学院附属邵逸夫医院普外科浙江大学微创外科研究所，杭州310016
Author(s):
Hong Defei;  Zheng Xueyong;  Yan Lifeng;  et al.
Department of General Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 310016, China
关键词:
腹腔镜脾切除术; 门奇断流术; 门脉高压症; 食管和胃静脉曲张
Keywords:
Laparoscopic splenectomy; Pericardial devascularization; Portal hypertension; Esophageal and gastric varices
分类号:
R657.6
文献标志码:
A
摘要:
目的探讨免切割闭合器完全腹腔镜巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的手术技巧和临床应用价值。方法2005年3月～2006年10月，对23例肝硬化门静脉高压致食道下端静脉曲张患者行完全腹腔镜下巨脾切除联合贲门周围血管离断术治疗，其中18例免切割闭合器应用二级脾蒂离断法切除脾脏，即处理脾蒂时逐支分离脾叶动静脉，边分离边用血管夹夹闭或用丝线结扎后离断血管，并用超声刀离断小网膜后，逐一将贲门周围曲张静脉直接用超声刀或可吸收夹夹闭后离断，将脾脏放入标本袋，拉出扩大的trocar孔外，剪碎后取出。结果18例手术获得成功，手术时间180~320 min，平均255 min。术中出血量200~1600 ml，平均450 ml。术后发生胸腔积液2例，左膈下脓肿1例，B超引导穿刺治愈，轻度腹水2例。无死亡病例。术后住院时间6~17 d，平均7.5 d。18例术后随访5-24个月，平均16.4月，术后20个月再出血1例，经胃镜下注射硬化剂治愈，余17例均无再出血。结论应用二级脾蒂离断法处理脾蒂可以避免腹腔镜巨脾切除联合贲门周围血管离断术应用切割闭合器，不仅节省费用，而且在腹腔镜巨脾切除中有独特的优势。
Abstract:
ObjectiveTo discuss the technique and clinical value of laparoscopic splenectomy (LS) without using EndoGIA combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.MethodsFrom March 2005 to October 2006, 23 patients with cirrhotic portal hypertensioninduced lower esophageal varices were treated with LS combined with pericardial devascularization. In 18 of the cases, the spleen was resected by disconnection of the secondary splenic pedicle without using endoGIA. During the operation, the splenic vessels were separated and disconnected by using absorbable clip or ligation respectively. And then the lesser omentum was cut using ultrasonic knife, and the pericardial varices devascularization was performed using the absorbable clips or ultrasonic knife. Finally, the spleen was placed into a bag, broken into small pieces, and removed from an enlarged trocar hole.ResultsThe operation was completed successfully in the 18 cases. The mean operation time was 255 min (range,180-320 min). The mean intraoperative blood loss was 450 ml (range, 200-1600 ml). After the operation, 2 patients developed plural effusion, 1 had subphrenic abscess, and 2 had mild ascites. The subphrenic abscess was cure by ultrasonographyguided puncture. The mean hospitalization was 7.5 days (range 6 to 17 days). No mortality occurred. All the patients were followed up for an averge of 16.4 months (range 5 to 24 months). No patient died after the operation. The mean hospital stay was 7.5 days (6-17 days). The cases were followed up for 5-24 months (mean, 16.4 months). One patient developed rebleeding 20 months after the operation, and was cured by injecting sclerosing agent under a gastroscope. The other 17 cases had no hemorrhage after the operation.ConclusionsIt is a lowcost and superior method to disconnect the secondary splenic pedicle without using endoGIA in LS combined with pericardial devascularization for the treatment of cirrhotic portal hypertension.

参考文献/References:

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更新日期/Last Update: 2013-10-22