Clinical study of total laparoscopic selective pericardial devascularization without splenectomy
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摘要:
目的 探讨保留脾脏的全腹腔镜下选择性贲门周围血管离断术治疗门静脉高压症上消化道出血的疗效。 方法 2011年2月~2014年12月期间接受保留脾脏的全腹腔镜选择性贲门周围血管离断术患者11例。观察其保脾断流手术前后血常规、肝功能、凝血功能、并发症以及手术时间、手术中出血量等指标，术后对患者进行长期随访，观察再出血率和生存情况。 结果 11例患者均在全腹腔镜下完成保留脾脏的选择性贲门周围血管离断术。手术时间110~225 min，平均157±31 min；手术中出血30~150 mL，平均83±37 mL。术后住院时间5~14 d(平均9.4 d)。患者手术后1周外周血白细胞、血小板、血红蛋白、总胆红素、白蛋白和凝血功能等与手术前比较均无明显统计学差异（P>0.05）。 结论 保留脾脏的全腹腔镜选择性贲门周围血管离断术为食管胃底静脉曲张破裂出血的患者提供了一种更为安全、有效的治疗手段。 -
关键词:
- 门静脉高压症 /
- 选择性贲门周围血管离断术 /
- 脾脏 /
- 腹腔镜手术
Abstract:Objective To evaluate the therapeutic effect of total laparoscopic selective pericardial devascularization without splenectomy. Methods The clinical data of 11 patients who received total laparoscopic selective pericardial devascularization without splenectomy from Feb 2011 to Dec 2014 were retrospectively analyzed. The blood routine, hepatic function, blood coagulation function, perioperative compliations, operation time and amount of bleeding were observed. The patients were followed-up and the re-bleeding rate and survival rate were observed. Results All of the 11 operations were completed successfully under laparoscope. The mean operation time was 157 min (ranged from 110 to 225 min). The mean intraoperative blood loss was 83 ml (ranged from 30 to 150 ml). The mean postoperative hospital stay was 9.4 days(ranged from 5 to 14 days). There was no significant difference in the levels of the leukocyte, platelet, hemoglobin, total billrubin, albumin and blood coagulation function between pre- and a week after postoperative (P>0.05). Conclusion Total laparoscopic selective pericardial devascularization without splenectomy is a safe and effective method for treatment of portal hypertension with upper gastrointestinal hemorrhage. -
表 1 手术前后血象和肝功能等变化情况(
$\, \overline{{x}}{{±}}{{s}}$ )指标 术前 术后1周 P 血白细胞（×109/L） 6.19±3.82 6.23±2.05 0.976 血红蛋白(g/L) 87.6±22.9 96.2±13.0 0.294 血小板（×109/L） 89±36 76±18 0.324 白蛋白（g/L） 30.75±6.64 32.17±4.13 0.552 总胆红素（μmol/L） 33.9±26.5 38.6±20.3 0.652 凝血功能(s) 18.12±4.20 17.42±2.49 0.640 谷草转氨酶（U/L） 37±34 52±25 0.260 谷丙转氨酶（U/L） 52±32 56±23 0.772 
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