Totally laparoscopic splenectomy plus pericardial devascularization in treatment of portal hypertension: importance of surgical teamwork and technical hints
10.3760/cma.j.issn.1007-8118.2019.08.012
- VernacularTitle:腹腔镜脾切除联合贲门周围血管离断术治疗门静脉高压症的团队协作与技巧
- Author:
Dingwei XU
1
;
Min SUN
;
Min WU
;
Jie HUANG
Author Information
1. 昆明医科大学第二附属医院肝胆胰外科三病区
- Keywords:
Hypertension,portal;
Laparoscopes;
Splenectomy;
Pericardia devascularization
- From:
Chinese Journal of Hepatobiliary Surgery
2019;25(8):611-615
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension,and advice on technical hints.Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January,2014 to December,2017.Results Totally laparoscopic procedures were performed successfully in 80 patients.The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding.One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml.The surgery was terminated and was continued one week later after stabilization of the patient.Of the 80 patients who underwent totally LSPD,the operation time ranged from 116.0 to 243.0 (146.0 ± 33.0) min.The intraoperative blood loss ranged from 60.0 to 600.0 (214.0 ± 31.0) ml.Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients.They responded successfully to antiplatelet and anticoagulant therapy.There were no perioperative deaths,variceal bleeding,gastrointestinal fistula and infection.Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons,totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension.Strict perioperative management provided a guarantee for the safe operation.
