目的 探讨肝硬化门静脉高压症脾切除术的技术难点及手术技巧.方法 回顾性分析2010年4月—2011年12月我科480例因肝硬化门静脉高压症行脾切断流术患者的临床资料.结果 450例行脾切除加贲门周围血管离断术,30例为单纯脾切除.开腹后到断脾胃韧带至脾切除完成平均耗时20min、出血50 ml、输血量400ml(125例未输血).术后并发症为腹腔感染(18例)、胸腔积液(5例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例).结论 门静脉高压症合并脾大(最大3.75kg,平均1.6 kg)使得脾周间隙狭小,脾蒂宽,脾胃韧带及脾结肠韧带内侧支血管丰富,血管壁薄,术中极易出血.脾切除术前先结扎脾动脉,后分离脾上下极,最后分离结扎脾蒂,是预防脾切除术中大出血的关键.%Objective To investigate the difficulties and surgical skills of splenectomy in cirrhotic patients with portal hy-pertension. Methods Clinical data of 480 cirrhotic patients undergoing splenectomy due to portal hypertension, who were admitted to our division from Apr. 2010 to Dec. 2011, were analyzed retrospectively. Results Totally 450 patients underwent splenectomy combined with pericardial devascularization, and 30 splenectomy alone. The average time of splenectomy was 20 minutes, the average blood loss was 50 ml, and the average intraoperative blood transfusion was 400 ml (125 patients received no blood transfusion). Postoperative complications were abdominal infection in 18 patients, pleural effusion in 5 patients, pulmonary infection in 1 patient, pancreatic fistula in 1 patient and intra-abdominal hemorrhage in 1 patient. Conclusions Because of narrow perisplenic spaces and wide splenic pedicle resulting from portal hypertension with enlarged spleen (the maximum weight of 3.75 kg, the average weight of 1.6 kg) as well as rich blood vessels in splenogastric ligament and splenocolic ligament, haemorrhage in the splenectomy is likely to occur. The procedure beginning with ligation of splenic artery before splenectomy, then mobilization of the upper and lower pole of spleen and last mobilization and ligation of splenic pedicle is crucial for the prevention of massive haemorrhage in the splenectomy.
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