优化腹腔镜脾切除和贲门周围血管离断术的临床研究-论文.pdf

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1、中华普通外科杂志2014年3月第29卷第3期ChinJGenSurg，March2014，Vo1．29，No．3·165·．脾脏疾病优化腹腔镜脾切除和贲门周围血管离断术的临床研究成剑洪德飞沈国棵谢志杰孙晓东王知非张远标黄东胜【摘要】目的探讨完全腹腔镜脾切除、贲门周围血管离断术(1aparoscopicsplenectomypluspericardialdevascularization，LSPD)的优化技术。方法应用预先结扎脾动脉，建立脾门后隧道，根据脾门形态应用直线或可转弯切割闭合器分次离断二级脾蒂、应用直线切

2、割闭合器离断胃冠状曲张静脉丛的方法优化LSPD来治疗门静脉高压症及脾功能亢进。结果29例患者手术均顺利完成，1例中转开腹。28例腹腔镜手术时间(207．2±59．3)min，术中出血量(287．7±212)ml，术中输血量(106．7±98．3)ml。术后肛门排气时间(4．6±1．7)d，术后住院时间(11．8±2．9)d。术后并发腹腔感染1例、门静脉血栓形成1例、肝功能衰竭者2例。无胰瘘、腹腔出血、及术后上消化道出血病例。1例死于术后肝功能衰竭，1例术后肝功能衰竭经过人工肝治疗后痊愈。结论优化的LSPD可提高全

3、腹腔镜手术成功率，缩短手术时间和减少术中出血量。【关键词】肝硬化；腹腔镜；高血压，门静脉；脾切除术；贲门周围血管离断术ModifiedlaparoscopicsplenectomyplusperieardialdevascularizationforthetreatmentofportalhypertensionChengJian，HongDefei，ShenGuoliang，eZho'ie，SunXiaodong，WangZhifel，ZhangYuanbiao．HuangDongsheng．Departmen

4、tofHepatopancreaticandMicroinvasiveSurgery．ejiangProvincialPeopleSHospita1．Hangzhou310014。ChinaCorrespondingauthor：HongDei。E—mail：hongdefi@163．com【Abstract】0bjectiveToevaluateamodifiedtotallylaparoscopicsplenectomypluspericardialdevascularization(LSPD)forthet

5、reatmentofportalhypertension．MethodsWeappliedthetechniqueofligatingthesplenicarteryinadvancefollowedbytheestablishmentofatunnelunderneaththesplenichilumandtheconsecutivetransectionofsecondarysplenicpediclesandgastriccoronaryveinwithEndo．GIAduringtheprocessofs

6、plenectomy．ResultsTotally1aparoscopicprocedureswereperformedsuccessfullyin28cases．Procedurewasconvertedtoopensurgeryinonecasebecauseofuncontrollablesplenicbleeding．0fthe28patientsthatreceivedthetotalLSPD．theoperationtimewas(207．2±59．3)min。intraoperativebloodl

7、osswas(287．7±212)ml。intraoperativebloodtransfusionvolumewas(106．7±98．3)ml，postoperativepassinggastimewas(4．6±1．7)d，postoperativehospitalstaywas(11．8±2．9)d．Abdominalinfection．postoperativeportalveinthrombosisandliverfailurewerefoundin1．1．2casesrespectively．The

8、rewerenopancreaticfistula，intraabdominalhemorrhage，postoperativeuppergastrointestinalhemorrhagecases．0Bepatientdiedofliverfailure，theotherwascuredbyartificiallivertherapy．ConclusionsThete