完全腹腔镜脾切除加门奇静脉断流术治疗门静脉高压症.docVIP

完全腹腔镜脾切除加门奇静脉断流术治疗门静脉高压症 　　作者：白剑峰　　作者单位：南京医科大学第一附属医院，江苏 南京 　　【摘要】目的：探讨完全腹腔镜脾切除加门奇静脉断流术治疗门静脉高压症的可行性、安全性和优缺点。方法：回顾分析我院2005年1月至2007年12月收治的12例肝硬化门静脉高压症合并脾功能亢进、上消化道出血(呕血或黑便史)患者的临床资料，12例均施行完全腹腔镜脾切除加门奇静脉断流术。结果：12例患者均在腹腔镜下完成手术，平均手术时间210min，术中平均出血340ml，平均住院12d，术后随访3～36个月。无一例发生再出血。结论：完全腹腔镜脾切除加门奇静脉断流术安全可行，疗效确切，是值得临床推广的治疗门静脉高压症的微创手术方式。 　　【关键词】 腹腔镜术 脾切除术 门奇静脉断流 门静脉高压症 　　Total laparoscopic splenectomy plus esophagogastric devascularization in the treatment of portal hypertension 　　BAI Jianfeng，SUN Yueming，LU Wenxiong，et al. 　　Dept.of Miniinvasive Surgery of the First Affiliated Hospital of Nanjing Medical College，Nanjing 210029，China 　　【Abstract】 Objective:To evaluate the feasibility and safety of total laparoscopic splenectomy plus esophagogastric devascularization in the treatment of portal hypertension.Methods:The patients suffering portal hypertension with the history of upper gastrointestinal tract hemorrhage underwent laparoscopic splenectomy plus esophagogastric devascularization from January 2005 to December 2007.The followup was from three months to three years，and the data was retrospectively analyzed.Results:The procedures were successful in all cases without conversion to open surgery.The mean operative time，blood loss in operation and postoperative hospitalization were 210min，340ml and 12d respectively.There was no mortality and serious postoperative complications.No bleeding event occured postoperatively.Conclusions:Total laparoscopic splenectomy plus esophagogastric devascularization is feasible，safe and less invasive in treatment of patients with portal hypertension，which is worth gereralized. 　　【Key words】 Laparoscopy;Splenectomy;Esophagogastric devascularization;Portal hypertension 　　门奇静脉断流术目前仍是国内治疗门静脉高压症合并脾功能亢进、上消化道出血的重要方法，此术式在我国占的比例较高。手助腹腔镜方法[1，2]使患者的创伤进一步减小，2005年1月至2007年12月我们为12例有上消化道出血病史的门静脉高压患者成功施行了完全腹腔镜脾切除加门奇静脉断流术，效果良好，且远期随访结果满意，现报道如下。 　　1 资料与方法 　　1.1 临床资料 　　本组12例中男9例，女3例，平均46.5岁。其中乙型肝炎后肝硬化8例，血吸虫性肝硬化2例，酒精性肝