腹腔镜治疗肝硬化门脉高压症临床应用.docVIP

腹腔镜治疗肝硬化门脉高压症临床应用【摘要】目的：探讨全腹腔镜下脾切除及门奇断流术的安全性,可行性、有效性。 方法：回顾性分析我院2006年9月至2010年8月对32例肝硬化合并门脉高压患者在全腹腔镜下脾切除及门奇断流术(包含结合开腹附加限制环的门腔分流手术22例)患者的临床资料。结果：32例患者中2例中转开腹，30例完成腹腔镜手术，其中8例行全腹腔镜下脾切除及门奇断流术，手术时间115～210min，平均手术时间144±28min，出血量50～250ml；另22例断流术后测得自由门静脉压力40～50cmH2O，故用开腹行附加限制环的门腔分流术，全阶段手术时间190～260min，平均232±35min,出血量150～400ml。全腹腔镜单纯脾切除+断流术患者术后第1天下床活动，结合开腹行附加限制环的门腔分流术术后第2天下床活动，5例术后发生腹水和左侧胸腔积液，保守治疗后痊愈，1例术后第9天出现胃漏，经再次手术治愈。术后住院时间9～56d，平均14.5d。结论：全腹腔镜下治疗肝硬化门脉高压症是安全、可行的，与传统开腹比较，其优势尚需进一步研究。 【关键词】腹腔镜,门脉高压,断流术,分流术,脾切除术 Treatment under total laparoscopic surgery on portal hypertenion in cirrhosis GONG Guang ,ZHAO Shao-yong,WANG Chang-song,ZHOU Wen-hao,HUANG Bin 【Abstract】Objective:to explore the security,validity,feasibility of total laparoscopic surgery to treat portal hypertension in cirrhosis.Methods:during 2006.9 to 2010.8,32 liver cirrhosis with portal hypertension cases had undergone laparoscopic splenectomy and combined pericardial devascularization,which including 8 cases had undergone limited portacaval shunt. All data were analyzed retrospectively. Results: Of all the 32 cases, 30 cases were succeed,2 cases turned to open sugery. 22 cases were total laparoscopic splenectomy and combined pericardial devascularization only,which operation time 115min-210min(144±28), hemorrhage quantity 50- 250ml . After pericardial devascularization,8 cases among 30 cases, FPP3.92～4.4 kPa,then plus limited portacaval shunt via open surgery, which operation time 190min-260min(232±35), hemorrhage quantity 150- 400ml . 5 of all cases had ascites or /and thorax fluid,one case’s stomach leaked,which had been healed by conservative way or operative way.The mean hospital stay was 14.5 day.Conclusions:the choice to treat portal hypertension under total laparoscope,is safe,valid,feasible. Key Words:laparoscopic surgery, pericardial devascularization, portacaval shunt, splenectomy,portal hypertension in cirrhosis 【中图分类号】 R657．34【文献标识码】A【文章编号】1004-5511（2012）06-0343-02 肝硬化门静脉高压症（portal hyperten