[1]孙加玉,李军,赵磊,等.腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症7例报告[J].中国微创外科杂志,2017,17(5):475-477.
 Sun Jiayu,Li Jun,Zhao Lei,et al.Laparoscopic Splenectomy and Esophagogastric Devascularization for Portal Hypertension: Report of 7 Cases[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):475-477.
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腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症7例报告()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
475-477
栏目:
经验交流
出版日期:
2017-07-14

文章信息/Info

Title:
Laparoscopic Splenectomy and Esophagogastric Devascularization for Portal Hypertension: Report of 7 Cases
作者:
孙加玉李军赵磊李正天许军魏云巍**
哈尔滨医科大学附属第一医院肿瘤、腔镜外科,哈尔滨150001
Author(s):
Sun Jiayu Li Jun Zhao Lei et al.
Department of Tumor and Endoscopic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
关键词:
腹腔镜脾切除门静脉高压症贲门周围血管离断术
Keywords:
LaparoscopySplenectomyPortal hypertensionEsophagogastric devascularization
文献标志码:
B
摘要:
目的探讨腹腔镜脾切除联合贲门周围血管离断术(laparoscopic splenectomy and esophagogastric devascularization,LSED)治疗肝硬化门静脉高压症(portal hypertension, PHT)的安全性和可行性。 方法我院2015年1月~2016年5月我科完成7例LSED,均在静吸复合麻醉下应用二级脾蒂离断法行LSED。术中超声刀、LigaSure相结合逐步离断二级脾蒂,完全游离脾脏,离断贲门周围血管至食管下段6~10 cm,分别于脾窝、食管旁放置引流管。术后2个月行钡餐检查。结果7例均在完全腹腔镜下完成脾切除联合贲门周围血管离断术,手术时间200~325 min,平均250.7 min。术中出血量200~1000 ml,平均421.4 ml。术后胸腔积液合并低热2例、术后脾窝积液合并发热1例,均经非手术治疗治愈。术后排气时间为3~ 4 d,住院时间9~12 d。7例随访3~17个月,平均10个月,术后2个月钡餐检查示食管胃底静脉曲张较术前明显减轻,均无再出血。结论LSED治疗PHT安全可行。
Abstract:
ObjectiveTo investigate the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LSED) for portal hypertension (PHT).MethodsFrom January 2015 to May 2016, 7 patients underwent LSED in our hospital. They were all operated by cutting secondary structures of the splenic pedicle under the combined intravenous-inhalation anesthesia. The secondary structures of the splenic pedicle were dissected cautiously with ultrasonic scalpel combinded with LigaSure. The esophagus was pulled downwards and the vessels were seperated to a point about 6-10 cm away from the gastric fundus. A drainage tube was routinely placed in spleen nest and nearby the esophagus postoperatively. Barium meal examination was required after 2 months. ResultsThe LSED procedure was completed in all the 7 patients. The median operation time was 250.7 min (range, 200-325 months), and the mean intraoperative blood loss was 421.4 ml (range, 200-1000 ml). Among them, 2 of them had leural effusion with low-grade fever, and 1 of them had spleen nest effusion with fever. All the complications were cured after symptomatic treatment. The postoperative exhaust time was 3-4 days and the postoperative hospital stay was 9-12 days. All the patients received follow-up observations for a mean of 10 months (range, 3-17 months). The barium meal examination after 2 months showed the degree of esophageal varices significantly reduced. No patients had hemorrhage.ConclusionLSED is safe and feasible for patients with PHT.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目:黑龙江省杰出青年科学基金(JC201416);卫计委资助课题项目(W2014RQ09);中俄转化医学专项基金(CR201415)
更新日期/Last Update: 2017-07-14