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,2019,18(12):1009-1013.[doi:10.3969/j.issn.1671-6353.2019.12.005]
腹腔镜脾大部分切除联合选择性贲门周围血管离断术治疗儿童肝内型门静脉高压症
- Title:
- Laparoscopic subtotal splenectomy plus selective periesophagogastric devascularization for intrahepatic portal hypertension in children
- Keywords:
- Laparoscopy; Splenectomy; Cardia; Vascular Surgical Procedures; Hypertension; Portal; Child
- 分类号:
- R726;R657.3+4;R654.4;R657.6
- 摘要:
- 目的 探讨腹腔镜脾大部分切除联合选择性贲门周围血管断流术治疗肝内型门静脉高压症伴脾功能亢进和食管静脉曲张出血的可行性和有效性。方法 7例肝硬化门静脉高压症患儿发展成静脉曲张破裂出血和严重脾功能亢进，接受腹腔镜脾大部分切除联合选择性贲门周围血管断流术，保留脾上极以提供胃底向膈或腹膜后的分流，同时选择性离断贲门周围侧支静脉和穿支静脉而保留食管旁静脉向奇静脉的自然分流。结果 手术均顺利完成，实施完全腹腔镜手术4例（手术时间210~260 min），手辅助腹腔镜手术3例（手术时间155~180 min）。术前白细胞、血小板和脾长径分别为（2.51±0.52）×109/L、（29.85±7.75）×109/L和（19.81±3.02）cm，术后白细胞、血小板和脾长径分别为（8.96±1.95）×109/L、（249.28±110.31）×109/L和（5.7±1.12）cm，差异有统计学意义（P<0.05）。随访1~7年，4例患儿食管静脉曲张套扎控制，没有再出血，生长发育正常。结论 腹腔镜脾大部分切除术联合选择性贲门周围血管断流术治疗儿童肝内型门静脉高压症是一种可行、安全、有效的干预手术。具有微创手术的优点并保留了脾脏的免疫功能。
- 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.
参考文献/References:
1 Guérin F,Bidault V,Gonzales E,et al.Meso-Rex bypass for extrahepatic portal vein obstruction in children[J].Br J Surg,2013,100(12):1606-1613.DOI:10.1002/bjs.9287.
2 Bai DS,Qian JJ,Chen P,et al.Laparoscopic azygoportal disconnection with and without splenectomy for portal hypertension[J].Int J Surg,2016,34:116-121.DOI:10.1016/j.ijsu.2016.08.519.
3 Seims AD,Breckler FD,Hardacker KD,et al.Partial versus total splenectomy in children with hereditary spherocytosis[J].Surgery,2013,154(4):849-853.DOI:10.1016/j.surg.2013.07.019.
4 Costi R,Castro Ruiz C,Romboli A,et al.Partial splenectomy:Who,when and how.A systematic review of the [2130] publishedcases[J].J Pediatr Surg,2019,54(8):1527-1538.DOI:10.1016/j.jpedsurg.2018.11.010.
5 苏有盛,吴封.内镜下食管静脉曲张套扎术后早期再出血的危险因素分析[J].中国医学工程,2018,26(1):27-29.DOI:10.19338/j.issn.1672-2019.2018.01.008. Su YS,Wu F.Risk factors of early rebleeding after endoscopic variceal ligation[J].China Medical Engineering,2018,26(1):27-29.DOI:10.19338/j.issn.1672-2019.2018.01.008.
6 中华医学会外科学分会门静脉高压症学组.肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识[J].中国实用外科杂志,2015,35(10):1086-1090.DOI:10.7504/CJPS.ISSN1005-2208.2015.10.16. Group of Portal Hypertension Syndromes of CMA’s Surgery Branch. Expert Consensus on Diagnosing & Treating Rupturing Hemorrhage due to Cirrhosis,Portal Hypertension & Gastroesophageal Varices[J].Chinese Journal of Practical Surgery,2015,35(10):1086-1090.DOI:10.7504/CJPS.ISSN1005-2208.2015.10.16.
7 de Ville de Goyet J,D’Ambrosio G,Grimaldi C.Surgical management of portal hypertension in children[J].Semin Pediatr Surg,2012,21(3):219-232.DOI:10.1053/j.sempedsurg.2012.05.005.
8 于增文,李索林,李英超,等.腹腔镜脾切除联合胃食管周围血管离断术治疗小儿门静脉高压症[J].临床小儿外科杂志,2011,10(4):267-269.DOI:10.3969/j.issn.1671-6353.2011.04.009. Yu ZW,Li SL,Li YC,et al,Laparoscopic splenectomy and periesophagogastric devascularization with endoligature for portal hypertension in children[J].J Clin Ped Surg,2011,10(4):267-269.DOI:10.3969/j.issn.1671-6353.2011.04.009.
9 Wang L,Xu J,Li F,et al.Partial splenectomy is superior to total splenectomy for selected patients withhemangiomas or cysts[J].World J Surg,2017,41(5):1281-1286.DOI:10.1007/s00268-016-3794-5.
10 la Villeon B,Zarzavadjian Le Bian A,Vuarnesson H,et al.Laparoscopic partial splenectomy:a technical tip[J].Surg Endosc,2015,29(1):94-99.DOI:10.1007/s00464-014-3638-z.
11 Kakinoki K,Okano K,Suto H,et al.Hand-assisted laparoscopic splenectomy for thrombocytopenia in patients with cirrhosis[J].Surg Today,2013,43(8):883-888.DOI:10.1007/s00595-012-0413-4.
12 李永彬,蔡云强,孟令威,等.手辅助与全腹腔镜选择性贲门周围血管离断术的安全性评价[J].腹部外科,2019,32(2):89-93.DOI:10.3969/j.issn.1003-5591.2019.02.004. Li YB,Cai YQ,Meng LW,et al.Safety evaluation of hand-assisted versus totallaparopic splenectomy combined with selective pericardial devascularization[J].Abdomin Surgery,2019,32(2):89-93.DOI:10.3969/j.issn.1003-5591.2019.02.004.
13 Chen H,Yang F,Li TT,et al.Comparison of Efficacy of Laparoscopic and Open Splenectomy Combined With Selective and Nonselective Pericardial Devascularization in Portal Hypertension Patients[J].Surg Laparosc Endosc Percutan Tech,2018,28(6):401-403.DOI:10.1097/SLE.0000000000000581.
相似文献/References:
[1]席红卫 崔强强 王建峰 李 健 崔 娆 靳园园.分级脾蒂结扎法在儿童腹腔镜脾切除术中的应用[J].临床小儿外科杂志,2010,9(03):0.
XI Hong-wei,CUI Qiang-qiang,WANG Jian-feng,et al.Application of fractional ligature of splenic stalk in laparoscopic splenectomy in Children.[J].Journal of Clinical Pediatric Surgery,2010,9(12):0.
[2]郑凯,胡敏.腹腔镜在小儿肠套叠复位术中的应用[J].临床小儿外科杂志,2008,7(01):16.
[3]宋连杰,李贵斌,李龙,等.腹腔镜在睾丸未触及诊断治疗中的应用[J].临床小儿外科杂志,2008,7(03):27.
[4]田琪 董亮 王晓晔 崔华雷. 腹腔镜在小儿卵巢良性畸胎瘤手术中的应用[J].临床小儿外科杂志,2011,10(04):258.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):258.
[5]于增文 李索林 李英超 徐伟立 时保军. 腹腔镜脾切除联合胃食管周围血管离断术治疗小儿门静脉高压症[J].临床小儿外科杂志,2011,10(04):267.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):267.
[6]张振强高群黄河陈晨张燕敏赛恺. 儿童阑尾脓肿的腹腔镜治疗[J].临床小儿外科杂志,2011,10(04):286.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):286.
[7]杨全安 邓素勤. 小儿急性阑尾炎的腹腔镜手术治疗[J].临床小儿外科杂志,2011,10(04):310.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):310.
[8]戴康临 陶强 陈快 陶俊峰 樊伟 雷俊 黄金狮. 新生儿腹腔镜下胆总管囊肿根治术体会[J].临床小儿外科杂志,2011,10(04):316.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):316.
[9]黄河 戚士芹 高群 陈晨 卢贤映 未德成. 腹腔镜辅助改良Soave术根治小儿先天性巨结肠[J].临床小儿外科杂志,2012,11(02):112.
[10]桂容花 彭旭 周福金 曲朝晖 张媛 马海峰. 腹腔镜与开腹手术治疗儿童坏疽性阑尾炎的比较[J].临床小儿外科杂志,2012,11(02):120.
[11]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(12):718.[doi:10.12260/lcxewkzz.2021.08.004]
备注/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