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.%Objective To investigate the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LSED) for portal hypertension (PHT).Methods From 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.Results The 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.Conclusion LSED is safe and feasible for patients with PHT.
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