直线型切割吻合器在门静脉高压症患者脾切除术中的应用(附27例报告)

摘要

目的 介绍采用直线切割吻合器离断肝硬化门脉高压患者脾蒂的方法,探讨其优越性.方法 总结27例肝硬化门静脉高压症患者应用直线切割吻合器离断脾蒂行脾切除的临床资料.术前均存在不同程度的脾功能亢进,27例胃镜提示食管重度静脉曲张,4例伴有Ⅰ型胃静脉曲张,2例伴有Ⅱ型胃静脉曲张,22例存在1～3次上消化道出血史.脾脏大小按3线分法14例符合巨脾诊断,CT增强扫描均显示脾周具有丰富的侧支循环.结果 本组平均手术时间45( 30～58) min,无手术死亡,无术中、术后大出血,无胰漏、胃漏、肠漏等脾切除相关并发症.结论 用直线切割吻合器离断脾蒂在诸多方面明显优于传统的脾蒂处理方法,是门脉高压患者脾切除术中离断脾蒂的理想方法之一.%Objective To introduce a neo-technique of the spleen pedicle severance in splenectomy for portal hypertension patients by using linear cutting staplers, and to discuss its advantages. Methods 27 cases of portal hypertension patients underwent splenectomy by using linear cutting staplers. All the 27 cases a-chieved hypersplenia and severe esophageal varices, and 6 cases achieved gastric varices in addition. And 14 cases belonged to megalosplenia according to " three line classification". Results The mean operation time was 45(30-58) minutes. All the patients got recovered without complications such as hemorrhea, pancreatic leakage and gastrointestinal fistula. Conclusions It is superior in many ways to traditional treatment methods of linear cutting staplers for spleen pedicel severance, which may be recommended as an ideal method for splenectomy in portal hypertension patients.