Hashizume Makoto, Tomikawa Morimasa, Akahoshi Tomohiko, Tanoue Kazuo, Gotoh Norikazu, Konishi Kozo, Okita Keishi, Tsutsumi Norifumi, Shimabukuro Rinshun, Yamaguchi Shohei, Sugimachi Keizo
Departments of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Hepatogastroenterology. 2002 May-Jun;49(45):847-52.
BACKGROUND/AIMS: Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension.
Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated. Forty-two patients had esophagogastric varices and twenty had a concomitant hepatocellular carcinoma. The indications for surgery were bleeding tendency due to thrombocytopenia (n = 40), difficulty in receiving treatment for hepatocellular carcinoma due to thrombocytopenia (n = 18), and sclerotherapy-resistant esophagogastric varices (n = 15).
A laparoscopic splenectomy was successfully performed in all the patients. The rate of conversion to conventional open surgery was 9.6% (7/73). The mean operative time was 210.1 +/- 101.9 minutes, and the estimated blood loss was 374.7 +/- 352.4 mL. There were no cases of mortality, and morbidity was encountered in 11.0% of patients. The increase in the platelet count correlated significantly to the spleen weight (P < 0.001). The platelet count had been maintained at over 10 x 10(4)/mm3 for over three years. Eighteen patients with hepatocellular carcinoma successfully underwent treatment for hepatocellular carcinoma after surgery and no recurrence of esophagogastric varices was encountered.
A laparoscopic splenectomy resulted in the successful secondary treatment of hepatocellular carcinoma and esophagogastric varices. Portal hypertension was not a contraindication. A laparoscopic approach is therefore the procedure of choice for a splenectomy in portal hypertension.
背景/目的：腹腔镜脾切除术目前的开展越来越多。然而，对于门静脉高压患者行腹腔镜脾切除术的有效性仍存在争议。
回顾了1992年2月至2000年10月期间接受腹腔镜脾切除术的73例门静脉高压患者，并评估了该手术治疗门静脉高压的有效性。42例患者有食管胃静脉曲张，20例伴有肝细胞癌。手术指征为血小板减少导致的出血倾向（n = 40）、因血小板减少难以接受肝细胞癌治疗（n = 18）以及硬化治疗无效的食管胃静脉曲张（n = 15）。
所有患者均成功进行了腹腔镜脾切除术。转为传统开放手术的比例为9.6%（7/73）。平均手术时间为210.1±101.9分钟，估计失血量为374.7±352.4毫升。无死亡病例，11.0%的患者出现了并发症。血小板计数的增加与脾脏重量显著相关（P < 0.001）。血小板计数在超过三年的时间里维持在10×10⁴/mm³以上。18例肝细胞癌患者术后成功接受了肝细胞癌治疗，未出现食管胃静脉曲张复发。
腹腔镜脾切除术成功地对肝细胞癌和食管胃静脉曲张进行了二期治疗。门静脉高压不是禁忌证。因此，腹腔镜手术是门静脉高压患者脾切除术的首选术式。
