Tian Linhuan,Li Suolin,Liu Lin,et al.Laparoscopic subtotal splenectomy plus selective periesophagogastric devascularization for intrahepatic portal hypertension in children[J].Journal of Clinical Pediatric Surgery,,18():1009-1013.[doi:10.3969/j.issn.1671-6353.2019.12.005]
Laparoscopic subtotal splenectomy plus selective periesophagogastric devascularization for intrahepatic portal hypertension in children
- Keywords:
- Laparoscopy; Splenectomy; Cardia; Vascular Surgical Procedures; Hypertension; Portal; Child
- CLC:
- R726;R657.3+4;R654.4;R657.6
- Abstract:
- Objective To explore the feasibility and effectivity of laparoscopic subtotal splenectomy (LSS) and selective pericardial devascularization for intrahepatic portal hypertension (IPH) with hypersplenism and variceal bleeding.Methods Seven patients of hepatic cirrhosis with variceal bleeding and severe hypersplenism underwent LSS plus selective pericardial devascularization.While preserving upper splenic pole supplying the gastrosplenic toward splenophrenic shunt, the periesophageal collateral vessels and perforating veins were devascularized.The stem of gastric coronary vein and paraesophageal collateral veins weren’t dissected for reserving portal blood flow toward azygous natural shunt.Results Total laparoscopy(n=4) and hand-assisted laparoscopy (n=3) were performed.The operative duration was (210~260 min vs.155~180 min).Compared with preoperative leukocyte(2.51±0.52)×109/L,platelet(29.85±7.75)×109/L and spleen length (19.81±3.02)cm respectively,the postoperative leukocyte is (8.96±1.95)×109/L,platelet is (249.28±110.31)×109/L and spleen length is (5.7±1.12)cm.The difference was statistically significant (P<0.05).During a follow-up period of 1 to 7 years,4 children of esophageal varices were controlled by endoscopic band ligation and development was normal.Conclusion Laparoscopic subtotal splenectomy with selective periesophagogastric devascularization is feasible,effective and safe for children with intrahepatic portal hypertension.This approach offers the benefits of minimal surgical trauma and preserves immune functions of splenic tissue.
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Memo
收稿日期:2019-10-15。
基金项目:国家卫生和健康委员会公益性行业科研专项（编号：201402007）
通讯作者:李索林,Email:lisuolin@263.net