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腹腔镜下胃左血管及脾动脉主干结扎在重症肝硬化门静脉高压症中的应用.doc

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腹腔镜下胃左血管及脾动脉主干结扎在重症肝硬化门静脉高压症中的应用.doc
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腹腔镜下胃左血管及脾动脉主干结扎在 重症肝硬化门静脉高压症中的应用 陈红兵 张寿儒 王吉胜 陶积春 甘肃省武威肿瘤医院胃肠外科 摘 要: 目的 探讨腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝硬化门静脉高压 症的临床效果。方法 2012年6月 2 014年12 月我科对26例肝硬化失代偿期门静 脉高压上消化道反复出血者, 腹腔镜下找到胃左动静脉, 根部用大号 Hem-o-lok 夹闭, 于脾动脉近端跳动最明显处, 游离出脾动脉约1 cm, 用大号 Hem-o-lok 夹闭。结果 26例手术均成功, 手术时间 (28.1±6.2) min, 出血量 (50.5±13.4) ml, 术后住院时间10 1 4 d, 平均 12 d。26例术后2周复查白细胞 (44.5 7 8.4) ×10 9 /L, 血小板 (124.5 3 38.4) ×10 9 /L。21例术后3个月复查, ALT 正常11例, 10例ALT 42.7 6 3.5 U/L;AST正常10例, 11例AST 51.5 6 3.4 U/L;TBIL 正常12例, 9例TBIL 22.5 3 8.4μmol/L;血浆白蛋白正常12例, 9例28.4 3 4.8 g/L。 21例术后 3个月胃镜提示食管胃底静脉曲张减轻, 轻度8例、中度 10例、重度 3例, 红色征阴性, 无活动出血, 与术前比较明显改善 (χ 2 =14.472, P=0.001) 。围手术期无死亡。21例随访24 6 0个月, 平均36个月, 无一例上消 化道再次出血发生。结论 腹腔镜下胃左血管及脾动脉近端主干结扎治疗重症肝 硬化门静脉高压症安全可行, 效果良好, 在肝功能ChildPugh分级为C级的患者 中值得推广应用。 关键词: 腹腔镜; 胃左血管结扎; 脾动脉结扎; 重症肝硬化; 门静脉高压症; 作者简介:陈红兵, E-mail: chbingstar218@ 163. com Application of Laparoscopic Ligation of Left Gastric Vessels and Main Splenic Artery for Severe Cirrhosis with Portal Hypertension Chen Hongbing Zhang Shouru Wang Jisheng Department of Gastrointestinal Surgery, Wuwei Tumor Hospital of Gansu Province; Abstract: Objective To investigate the clinical efficacy of laparoscopic ligation of left gastric vessels and main splenic artery for severe cirrhosis with portal hypertension. Methods From June 2012 to December 2014, there were 26 cases of decompensated liver cirrhosis with portal hypertension who had repeated digestive tract hemorrhage in our department. The left gastric artery and vein were identified and ligated near the origins with Hem-o-lok clipping under laparoscopy. The proximal splenic artery was mobilized for about 1 cm in length at the most obvious beats and then was ligated with large-sized Hem-o-lok clipping. Results The operations were successfully completed in all the 26 cases. The operation time was ( 28. 1 ± 6. 2) min, the blood loss was ( 50. 5 ± 13. 4) ml, and the postoperative hospitalization was 10-14 d ( mean, 12 d) . At the 2 weeks after surgery, t
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