CAJ | 학술논문

目的：探讨腹腔镜脾切除+贲门周围血管离断术（断流术）在治疗肝硬化门静脉高压症中的安全性和应用价值。方法回顾性研究2011年11月至2013年11月在中山大学附属第三医院岭南医院接受腹腔镜断流术的32例肝硬化门静脉高压症患者临床资料。其中男26例，女6例；年龄40～69岁，中位年龄53岁。所有患者均签署知情同意书，符合医学伦理学规定。患者在气管插管静脉复合麻醉下行腹腔镜断流术。术前1周戒烟、戒酒，行呼吸功能训练和床上排便训练。术后严密监测生命体征，观察引流量等情况。结果全部患者腹腔镜断流术均成功完成。平均手术时间为（110±15）min，术中出血量（200±52）ml，住院时间（7±2）d。术后3个月内定期行凝血功能和门静脉彩色多普勒超声检查，术后发生门静脉血栓7例，根据血小板和血栓情况给予调整抗血小板和抗凝治疗后治愈。围手术期无发生死亡、大出血、消化道瘘及感染。结论腹腔镜断流术是治疗肝硬化门静脉高压症的一种安全、有效方法，严密的围手术期处理可以为手术安全提供保障。
목적：탐토복강경비절제+분문주위혈관리단술（단류술）재치료간경화문정맥고압증중적안전성화응용개치。방법회고성연구2011년11월지2013년11월재중산대학부속제삼의원령남의원접수복강경단류술적32례간경화문정맥고압증환자림상자료。기중남26례，녀6례；년령40～69세，중위년령53세。소유환자균첨서지정동의서，부합의학윤리학규정。환자재기관삽관정맥복합마취하행복강경단류술。술전1주계연、계주，행호흡공능훈련화상상배편훈련。술후엄밀감측생명체정，관찰인류량등정황。결과전부환자복강경단류술균성공완성。평균수술시간위（110±15）min，술중출혈량（200±52）ml，주원시간（7±2）d。술후3개월내정기행응혈공능화문정맥채색다보륵초성검사，술후발생문정맥혈전7례，근거혈소판화혈전정황급여조정항혈소판화항응치료후치유。위수술기무발생사망、대출혈、소화도루급감염。결론복강경단류술시치료간경화문정맥고압증적일충안전、유효방법，엄밀적위수술기처리가이위수술안전제공보장。
ObjectiveTo investigate the safety and application value of laparoscopic splenectomy combined with pericardial devascularization (devascularization) in the treatment of cirrhosis-induced portal hypertension.MethodsClinical data of 32 patients with cirrhosis and portal hypertension undergoing laparoscopic devascularization in Lingnan Hospital, the Third Afifliated Hospital of Sun Yat-sen University from November 2011 to November 2013 were retrospectively studied. Among the 32 patients, 26 were males and 6 were females with the age ranging from 40 to 69 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients received laparoscopic devascularization under intratracheal intubation anesthesia combined with intravenous anesthesia. One week before surgery, the patients were instructed to quit smoking and drinking, and received respiratory function training and in-bed toilet training. Vital signs were closely monitored and drainage volume was observed after surgery.ResultsAll patients received larparoscopic devascularization successfully, with the average operation time of (110±15) min, intraoperative blood loss of (200±52) ml and length of hospital stay of (7±2) d. The blood coagulation and color Doppler ultrasound of portal vein were regularly followed up within 3 months after surgery. Seven cases suffered portal vein thrombosis after surgery and recovered after adjusting the anti-platelet and anti-coagulation therapy according to the situation of platelets and thrombus. No death, massive hemorrhage, digestive tract ifstula and infection occurred during perioperative period.ConclusionsLaparoscopic devascularization in the treatment of cirrhosis-induced portal hypertension is safe and effective. The rigorous perioperative management guarantees the safety of surgery.