CAJ | 학술논문

目的：探讨腹腔镜脾切除加贲门食管周围血管离断术的疗效以及术后并发症的预防与处理。方法回顾性分析2010年1月～2014年3月应用腹腔镜脾切除加贲门食管周围血管离断术治疗的38例肝炎后肝硬化伴门静脉高压症病例的临床资料。结果所有病例均成功完成手术。手术时间238．42±75．25 min，术中出血量200．53±90．81 mL，总住院时间22．71±7．19 d，术后住院时间12．18±4．49 d，术后胃肠动力恢复时间3．45±0．89 d。手术前后肝功能结果无明显差异，而PLT 术后明显升高（48．2±19．7 vs．术前227．5±80．5，P＜0．001）。随访过程中有6例发生再出血，3例发生肝性脑病，12例发生门静脉血栓，1例胰尾脓肿均经保守治疗后好转。结论腹腔镜脾切除加贲门食管周围血管离断术是一种安全，有效，且创伤小的门静脉高压症治疗手段。
목적：탐토복강경비절제가분문식관주위혈관리단술적료효이급술후병발증적예방여처리。방법회고성분석2010년1월～2014년3월응용복강경비절제가분문식관주위혈관리단술치료적38례간염후간경화반문정맥고압증병례적림상자료。결과소유병례균성공완성수술。수술시간238．42±75．25 min，술중출혈량200．53±90．81 mL，총주원시간22．71±7．19 d，술후주원시간12．18±4．49 d，술후위장동력회복시간3．45±0．89 d。수술전후간공능결과무명현차이，이PLT 술후명현승고（48．2±19．7 vs．술전227．5±80．5，P＜0．001）。수방과정중유6례발생재출혈，3례발생간성뇌병，12례발생문정맥혈전，1례이미농종균경보수치료후호전。결론복강경비절제가분문식관주위혈관리단술시일충안전，유효，차창상소적문정맥고압증치료수단。
Objective To explore the treatment effect and complication therapy of laparoscopic splenectomy and esophagogastric devascularization for portal hypertension. Methods The clinical data of 38 cases from January 2010 to March 2014 who underwent laparoscopic splenectomy and esophagogastric devascularization for liver cirrhosis and portal hypertension were analyzed. Results All operations in this study were performed successfully. The operation time was 238.42±75.25 min ,.the blood loss during operation was 200.53 ±90.81 ml ,.the total hospital stay was 22.71 ±7.19 d ,.the postoperative hospital stay was 12.18 ±4.49 d ,.and the recovery time of gastrointestinal function was 3.45 ±0.89 d. There were no significant differences in liver function between the preoperative and postoperative data. While the postoperative levels of PLT were significantly higher (48.2±19.7 vs. 227.5± 80.5,P<0.001). During the follow-up, rebleeding occurred in 6 cases, hepatic encephalopathy occurred in 3 cases,.portal vein thrombosis occurred in 12 cases,.pancreas abscess occurred in 1 case..All complications were treated in conservative way and the patients got recovery. Conclusion Laparoscopic splenectomy and esophagogastric devascularization is a safe,.effective,.minimally invasive procedure for the management of portal hypertension.