中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
Chinese Journal of General Surgery
2015年
11期
866-869
,共4页
蒋国庆%石磊%柏斗胜%钱建军%陈平%金圣杰
蔣國慶%石磊%柏鬥勝%錢建軍%陳平%金聖傑
장국경%석뢰%백두성%전건군%진평%금골걸
肝肿瘤%高血压,门静脉%腹腔镜%脾切除术
肝腫瘤%高血壓,門靜脈%腹腔鏡%脾切除術
간종류%고혈압,문정맥%복강경%비절제술
Liver neoplasms%Hypertension,portal%Laparoscopes%Splenectomy
目的 探讨同步的腹腔镜下脾切、断流联合腹腔镜下肝癌切除术同时治疗门静脉高压性脾功能亢进、胃底食管静脉曲张破裂出血及原发性肝细胞肝癌的可行性及安全性.方法 回顾性分析2015年4-5月扬州大学临床医学院肝胆外科收治的2例肝硬化性门脉高压患者同时并发继发性脾功能亢进、上消化道出血与原发性肝细胞肝癌的临床资料.2例患者均施行同步的腹腔镜下脾切、断流联合腹腔镜下肝癌切除术,并同时行术中的自体血回输.手术按照先行无菌手术的原则,先行脾切和断流,并同时进行自体血回输,之后再进行肝切除.结果 2例手术均成功地施行.手术时间分别为190 min和205 min;术中出血量分别为180 ml和260 ml;术中同种异体输血量均为0 ml;术后住院时间分别为8d和9d.2例患者术后均恢复顺利,无严重并发症.结论 在掌握适当的手术适应证的情况下,同步的腹腔镜下脾切、断流联合腹腔镜下肝癌切除术同时治疗门静脉高压性脾功能亢进、胃底食管静脉曲张破裂出血及原发性肝细胞肝癌是安全、可行且疗效确切.
目的 探討同步的腹腔鏡下脾切、斷流聯閤腹腔鏡下肝癌切除術同時治療門靜脈高壓性脾功能亢進、胃底食管靜脈麯張破裂齣血及原髮性肝細胞肝癌的可行性及安全性.方法 迴顧性分析2015年4-5月颺州大學臨床醫學院肝膽外科收治的2例肝硬化性門脈高壓患者同時併髮繼髮性脾功能亢進、上消化道齣血與原髮性肝細胞肝癌的臨床資料.2例患者均施行同步的腹腔鏡下脾切、斷流聯閤腹腔鏡下肝癌切除術,併同時行術中的自體血迴輸.手術按照先行無菌手術的原則,先行脾切和斷流,併同時進行自體血迴輸,之後再進行肝切除.結果 2例手術均成功地施行.手術時間分彆為190 min和205 min;術中齣血量分彆為180 ml和260 ml;術中同種異體輸血量均為0 ml;術後住院時間分彆為8d和9d.2例患者術後均恢複順利,無嚴重併髮癥.結論 在掌握適噹的手術適應證的情況下,同步的腹腔鏡下脾切、斷流聯閤腹腔鏡下肝癌切除術同時治療門靜脈高壓性脾功能亢進、胃底食管靜脈麯張破裂齣血及原髮性肝細胞肝癌是安全、可行且療效確切.
목적 탐토동보적복강경하비절、단류연합복강경하간암절제술동시치료문정맥고압성비공능항진、위저식관정맥곡장파렬출혈급원발성간세포간암적가행성급안전성.방법 회고성분석2015년4-5월양주대학림상의학원간담외과수치적2례간경화성문맥고압환자동시병발계발성비공능항진、상소화도출혈여원발성간세포간암적림상자료.2례환자균시행동보적복강경하비절、단류연합복강경하간암절제술,병동시행술중적자체혈회수.수술안조선행무균수술적원칙,선행비절화단류,병동시진행자체혈회수,지후재진행간절제.결과 2례수술균성공지시행.수술시간분별위190 min화205 min;술중출혈량분별위180 ml화260 ml;술중동충이체수혈량균위0 ml;술후주원시간분별위8d화9d.2례환자술후균회복순리,무엄중병발증.결론 재장악괄당적수술괄응증적정황하,동보적복강경하비절、단류연합복강경하간암절제술동시치료문정맥고압성비공능항진、위저식관정맥곡장파렬출혈급원발성간세포간암시안전、가행차료효학절.
Objective To investigate the feasibility and safety of elective synchronous laparoscopic splenectomy plus portaazygous disconnection and hepatectomy for cirrhotic portal hypertension patients with hypersplenism, esophageal and gastric variceal bleeding and hepatocellular carcinoma.Methods Two hepatocellular carcinoma patients with a history of upper gastrointestinal hemorrhage and secondary hypersplenism underwent one stage, non-emergency laparoscopic splenectomy plus portaazygous disconnection and hepatectomy between April 2015 and May 2015 in our department.Autologous red cell salvage was used during the operation.Liver resection was performed after splenectomy, portaazygous disconnection and the use of cell saver.Results The two operations were performed successfully.The operative time was 190 min and 205 min respectively, Volume of intraoperative bleeding was 180 ml and 260 ml.There was no intraoperative homologous blood transfusion.The two patients recovered smoothly, without major complications and postoperative hospital stay was 8 d and 9 d.Conclusions The procedure of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy for cirrhotic patients with hepatocellular carcinoma, hypersplenism and esophageal and gastric variceal bleeding is safe and feasible.
