摘要
目的探讨腹腔镜脾大部分切除联合选择性贲门周围血管断流术治疗肝内型门静脉高压症伴脾功能亢进和食管静脉曲张出血的可行性和有效性。方法7例肝硬化门静脉高压症患儿发展成静脉曲张破裂出血和严重脾功能亢进,接受腹腔镜脾大部分切除联合选择性贲门周围血管断流术,保留脾上极以提供胃底向膈或腹膜后的分流,同时选择性离断贲门周围侧支静脉和穿支静脉而保留食管旁静脉向奇静脉的自然分流。结果手术均顺利完成,实施完全腹腔镜手术4例(手术时间210~260 min),手辅助腹腔镜手术3例(手术时间155~180 min)。术前白细胞、血小板和脾长径分别为(2.51±0.52)×109/L、(29.85±7.75)×109/L和(19.81±3.02)cm,术后白细胞、血小板和脾长径分别为(8.96±1.95)×109/L、(249.28±110.31)×109/L和(5.7±1.12)cm,差异有统计学意义(P<0.05)。随访1~7年,4例患儿食管静脉曲张套扎控制,没有再出血,生长发育正常。结论腹腔镜脾大部分切除术联合选择性贲门周围血管断流术治疗儿童肝内型门静脉高压症是一种可行、安全、有效的干预手术。具有微创手术的优点并保留了脾脏的免疫功能。
Objective To explore the feasibility and effectivity of laparoscopic subtotal splenectomy(LSS)and selective pericardial devascularization for intrahepatic portal hypertension(IPH)with hypersplenism and variceal bleeding.Methods Seven patients of hepatic cirrhosis with variceal bleeding and severe hypersplenism underwent LSS plus selective pericardial devascularization.While preserving upper splenic pole supplying the gastrosplenic toward splenophrenic shunt,the periesophageal collateral vessels and perforating veins were devascularized.The stem of gastric coronary vein and paraesophageal collateral veins weren t dissected for reserving portal blood flow toward azygous natural shunt.Results Total laparoscopy(n=4)and hand-assisted laparoscopy(n=3)were performed.The operative duration was(210~260 min vs.155~180 min).Compared with preoperative leukocyte(2.51±0.52)×109/L,platelet(29.85±7.75)×109/L and spleen length(19.81±3.02)cm respectively,the postoperative leukocyte is(8.96±1.95)×109/L,platelet is(249.28±110.31)×109/L and spleen length is(5.7±1.12)cm.The difference was statistically significant(P<0.05).During a follow-up period of 1 to 7 years,4 children of esophageal varices were controlled by endoscopic band ligation and development was normal.Conclusion Laparoscopic subtotal splenectomy with selective periesophagogastric devascularization is feasible,effective and safe for children with intrahepatic portal hypertension.This approach offers the benefits of minimal surgical trauma and preserves immune functions of splenic tissue.
作者
田琳欢
李索林
刘林
孙驰
李英超
Tian Linhuan;Li Suolin;Liu Lin;Sun Chi;Li Yingchao(Department of Pediatric Surgery,Second Hospital,Hebei Medical University,Shijiazhuang 050000,China)
出处
《临床小儿外科杂志》
CAS
2019年第12期1009-1013,共5页
Journal of Clinical Pediatric Surgery
基金
国家卫生和健康委员会公益性行业科研专项(编号:201402007)
