Laparoscopic Splenectomy Combined with Pericardial Devascularization for Treatment of Portal Hypertension Induced by Liver Cirrohosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PAN Guangdong , YANG Jianqing , CAI Jingming , LIU Qiang , CHU Guangping , YUAN Lin , XIAO Yi , TAN Shengqiang , LIU Zhen , LU Xin , LI Xiaocheng , LIU Linsen

Department of Hepatobiliaropancreatic Surgery, Liuzhou People’s Hospital, Liuzhou 545006, Guangxi Zhuangzu Autonomous Region, China;

Corresponding author：

Keywords：

Portal hypertension; Esophageal and gastric varices; Laparoscopic splenectomy; Esophagogastric devascularization

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ObjectiveTo evaluate the operative technique and clinical efficacy of laparoscopic splenectomy (LS) combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis. MethodsTwelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010, which clinical data were analyzed and summarized retrospectively. ResultsThe splenic artery was ligated before the treatment of splenic pedicle in 12 cases, LS combined with pericardial devascularization was successfully performed in 10 cases, 7 cases of which were treated by the level two transection method of splenic pedicle, and 2 cases were converted to open surgery due to intraoperative bleeding. In 10 cases, the operative time was 180-300 min (average 210 min), and intraoperative blood loss was 200-1 000 ml (average 480 ml). The postoperative hospital stay was 8-15 d (average 9 d)， the postoperative complications included plural effusion （ lt;300 ml） in 2 cases， mild ascites （ lt;300 ml） in 2 cases, and mild pancreatic leakage in 1 case， but all were cured eventually， and no mortality occurred. Followup was conducted in 12 patients for 4 to 20 months (average 7 months), and no rebleeding occurred. ConclusionsLS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis. The keys to success include ligation of splenic artery, and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.

Citation： PAN Guangdong,YANG Jianqing,CAI Jingming,LIU Qiang,CHU Guangping,YUAN Lin,XIAO Yi,TAN Shengqiang,LIU Zhen,LU Xin,LI Xiaocheng,LIU Linsen,.. Laparoscopic Splenectomy Combined with Pericardial Devascularization for Treatment of Portal Hypertension Induced by Liver Cirrohosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1205-1208. doi: Copy

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10.	谭敏. 腹腔镜脾脏切除术 [J]. 中国实用外科杂志， 2004， 24（12）： 761762.
11.	Schlachta CM, Poulin EC, Mamazza J. Laparoscopic splenectomy for hematologic malignancies [J]. Surg Endosc, 1999， 13(9): 865868.
12.	王跃东，叶再元，竺扬文，等. 腹腔镜脾切除术100例 [J]. 中华肝胆外科杂志， 2006， 12（9）： 599600.
13.	孙谷，陆文熊，付赞，等. 腹腔镜下脾切除术—10例报告 [J]. 南京医科大学学报（自然科学版）， 2004， 24（1）： 6364.

1. Uranues S， Alimoglu O. Laparoscopic surgery of the spleen [J]. Surg Clin North Am， 2005， 85(1): 7590.
2. 姚英民，刘青光，扬威，等. 腹腔镜脾切除贲门周围血管离断术 [J]. 中华肝胆外科杂志， 2009， 15（3）： 226227.
3. 谭敏，许曦彦，吴志棉，等. 腹腔镜技术在脾脏切除术中的应用 [J]. 中华外科杂志， 2001， 39（8）： 599601.
4. 洪德飞，郑雪咏，彭淑牖，等. 完全腹腔镜巨脾联合贲门周围血管离断术治疗门静脉高压症 [J]. 中华医学杂志， 2007， 87（12）： 820822.
5. 冯泽荣，贺孝文，廖轲. 手助腹腔镜与开腹脾切除加门奇静脉阻断术的前瞻性对比研究 [J]. 腹腔镜外科杂志， 2003， 8（4）： 224226.
6. 许军，刘昶，王东，等. 手助腹腔镜脾切除联合贲门周围血管离断术在门静脉高压症中的临床应用: 附14例报告 [J]. 中华肝胆外科杂志， 2007， 13（5）： 311313.
7. 郑璐，李靖，梁平. 腹腔镜脾切除术的研究进展 [J]. 中国普外基础与临床杂志， 2005， 12（6）： 574576.
8. 李永双，金俊哲，梁健，等. 手助腹腔镜脾切除加门奇静脉断流术对机体应激反应的影响 [J]. 中国普外基础与临床杂志， 2008， 15（12）： 873876.
9. 潘光栋，杨建青，褚光平，等. Ligasure联合超声刀在肝胆外科开腹手术中的应用 [J]. 微创医学， 2009， 4(4): 340342.
10. 谭敏. 腹腔镜脾脏切除术 [J]. 中国实用外科杂志， 2004， 24（12）： 761762.
11. Schlachta CM, Poulin EC, Mamazza J. Laparoscopic splenectomy for hematologic malignancies [J]. Surg Endosc, 1999， 13(9): 865868.
12. 王跃东，叶再元，竺扬文，等. 腹腔镜脾切除术100例 [J]. 中华肝胆外科杂志， 2006， 12（9）： 599600.
13. 孙谷，陆文熊，付赞，等. 腹腔镜下脾切除术—10例报告 [J]. 南京医科大学学报（自然科学版）， 2004， 24（1）： 6364.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Splenectomy Combined with Pericardial Devascularization for Treatment of Portal Hypertension Induced by Liver Cirrohosis

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