Objective To investigate the clinical efficacy of laparoscopic ligation of left gastric vessels and main splenic artery for severe cirrhosis with portal hypertension. Methods From June 2012 to December 2014, there were 26 cases of decompensated liver cirrhosis with portal hypertension who had repeated digestive tract hemorrhage in our department. The left gastric artery and vein were identified and ligated near the origins with Hem-o-lok clipping under laparoscopy. The proximal splenic artery was mobilized for about 1 cm in length at the most obvious beats and then was ligated with large-sized Hem-o-lok clipping. Results The operations were successfully completed in all the 26 cases. The operation time was (28. 1 ± 6. 2) min, the blood loss was (50. 5 ± 13. 4) ml, and the postoperative hospitalization was 10-14 d (mean, 12 d). At the 2 weeks after surgery, the white blood cell was (44. 5-78. 4) × 109/L and the platelet was (124. 5-338. 4) × 109/L. A total of 21 cases were reviewed at the 3 months after surgery. The ALT levels were normal in 11 cases and 42. 7-63. 5 U/L in 10 cases. The AST levels were normal in 10 cases and 51. 5-63. 4 U/L in 11 cases. The TBIL levels were normal in 12 cases and 22. 5-38. 4 μmol/L in 9 cases. The plasma albumin levels were normal in 12 cases and 28. 4-34. 8 g/L in 9 cases. Gastroscopy showed relieved esophageal and gastric varices, including 8 mild cases, 10 moderate cases, and 3 severe cases. The red color sign was negative and no active bleeding was seen, which were significantly improved as compared to preoperation(χ2 =14. 472,P=0. 001). No peri-operative death occurred. Follow-ups for 24-60 months (mean, 36 months) in 21 cases found no recurrent digestive tract hemorrhage. Conclusion Laparoscopic ligation of left gastric vessels and main splenic artery for severe cirrhosis with portal hypertension is safe, feasible, and effective, being worthy of popularization in patients with class C of Child-Pugh criteria.%目的 探讨腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝硬化门静脉高压症的临床效果.方法2012年6月~2014年12月我科对26例肝硬化失代偿期门静脉高压上消化道反复出血者,腹腔镜下找到胃左动静脉,根部用大号Hem-o-lok夹闭,于脾动脉近端跳动最明显处,游离出脾动脉约1 cm,用大号Hem-o-lok夹闭.结果26例手术均成功,手术时间(28.1±6.2)min,出血量(50.5±13.4)ml,术后住院时间10~14 d,平均12 d.26例术后2周复查白细胞(44.5~78.4)×109/L,血小板(124.5~338.4)×109/L.21例术后3个月复查,ALT正常11例,10例ALT 42.7~63.5 U/L;AST正常10例,11例AST 51.5~63.4 U/L;TBIL正常12例,9例TBIL 22.5~38.4μmol/L;血浆白蛋白正常12例,9例28.4~34.8 g/L.21例术后3个月胃镜提示食管胃底静脉曲张减轻,轻度8例、中度10例、重度3例,红色征阴性,无活动出血,与术前比较明显改善(χ2=14.472,P=0.001).围手术期无死亡.21例随访24~60个月,平均36个月,无一例上消化道再次出血发生.结论腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝硬化门静脉高压症安全可行,效果良好,在肝功能Child-Pugh分级为C级的患者中值得推广应用.
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