完全腹腔镜脾动脉瘤隔绝联合贲门周围血管离断术治疗门静脉高压症合并脾动脉瘤的临床价值

Clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension complicated with splenic aneurysm

    摘要
  • 摘要:
    目的 探讨完全腹腔镜脾动脉瘤隔绝联合贲门周围血管离断术治疗门静脉高压症合并脾动脉瘤的临床价值。
    方法 采用回顾性描述性研究方法。收集2013年1月至2020年5月2家医学中心收治的17例（深圳大学总医院15例,武汉市第一医院2例）门静脉高压症合并脾动脉瘤患者的临床资料；男7例,女10例；年龄为（59±14）岁。所有患者行完全腹腔镜脾动脉瘤隔绝联合贲门周围血管离断术。观察指标：（1）手术及术后情况。（2）并发症情况。（3）随访情况。采用门诊和电话方式进行随访,了解患者术后3个月动脉瘤体隔绝治疗效果及血液复流情况、门静脉内血栓情况和生存情况。随访时间截至2020年12月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（范围）表示。
    结果 （1）手术及术后情况。17例患者均顺利完成手术,无围手术期死亡患者。17例患者手术时间为（181±30）min,术中出血量为187（90~420）mL,术后第3天白细胞计数为（9±4）×109/L,红细胞计数为（3.5±0.9）×1012/L,血红蛋白为（86±17）g/L,血清白蛋白为（36±7）g/L,术后拔除腹腔引流管时间为（7±4）d,术后住院时间为（11±4）d。（2）并发症情况。17例患者术后均有腹水,予利尿剂口服治疗后好转。所有患者未见腹腔内大出血、消化道瘘、胸腔积液、感染、脓肿形成、发热、血管栓塞等并发症。（3）随访情况：17例患者均获得随访,随访时间为28.6（7.0~84.0）个月。随访期间,所有患者脾动脉瘤腔隔绝完全,其内未见血液复流；门静脉内未见血栓形成；无死亡患者。
    结论 完全腹腔镜脾动脉瘤隔绝联合贲门周围血管离断术治疗门静脉高压症合并脾动脉瘤安全、可行。

     

    Abstract:
    Objective To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range).
    Results (1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90‒420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×109/L, (3.5±0.9)×1012/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0‒84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died.
    Conclusion Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.

     

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