腹腔镜脾切除术联合心包断流术治疗门静脉高压症引起的脾功能亢进和食管静脉曲张出血
2024年11月15日
随着腹腔镜技术的飞速发展，腹腔镜脾切除术联合心包断运重建术的微创益处日益显现。在这种情况下，我们提出了一种方案，用于进行腹腔镜脾切除术和心包断运重建术，以治疗门静脉高压症引起的脾功能亢进和食管静脉曲张出血。
[导师]首先，在患者身上做一个切口，然后将 10 毫米的套管针和腹腔镜插入脐下方。在通过腹腔镜直接观察的情况下，分别在左中腹部和右中腹部放置一个 12 毫米的套管针。随后，在左右上腹部放置一个五毫米的套管针。对于脾动脉结扎，使用超声谐波手术刀切开胃结肠韧带和胃脾韧带。结扎并切断左胃上层和短胃血管。暴露小网膜囊和胰腺。在胰腺上缘切开后腹膜。然后解剖并结扎脾动脉。从脾下极开始进行脾切除术，切断脾结肠韧带。向腹侧抬起脾脏下极，切断胸膜韧带。接下来，将胰腺尾部与脾蒂分开，切断脾上极附近的脾膈韧带。使用带有墨盒的线性吻合装置，切断脾蒂。对于心包血管断绝术，将胃抬起并拉向头侧。解剖并暴露胃后部的左胃血管。然后结扎并切断左胃血管。接下来，将胃的后壁向贲门解离。结扎并切断胃后部血管。现在将胃拉向左下角，切开小网膜以及贲门的前浆膜。然后解剖并暴露胃冠状静脉的分支，进入胃壁。结扎并切断冠状静脉的胃支。切开膈下前食管浆膜。然后解剖并解离长度不小于六厘米的下食管。然后，结扎并切断膈下血管和冠状静脉的食管分支。在将切除的脾脏装入标本袋之前，仔细检查贲门周围是否有残留的静脉曲张血管。最后用无菌生理盐水冲洗手术区域。仔细检查活动性出血和胰腺或胃肠道侧支损伤后，在左横膈膜下方放置引流管。所有患者均成功接受腹腔镜保脾远端胰腺切除术，未转为开放手术。平均手术时间约为215.63分钟，平均术中出血量为128.75毫升。术后平均引流时间为5.5 d，术后平均住院时间约为6.5 d。术后并发症发生率为25%，肺部感染、腹水各1例。
概述
本文介绍了一种行腹腔镜脾脏切除联合心包去血管化的协议。该技术旨在治疗门静脉高压引起的脾功能亢进和食管静脉曲张出血。
关键研究组成部分
科学领域
- 微创手术
- 腹腔镜技术
- 门静脉高压治疗
背景
- 腹腔镜脾脏切除提供微创的好处。
- 心包去血管化用于管理门静脉高压的并发症。
- 脾功能亢进和食管静脉曲张出血是重大的临床挑战。
- 手术技术的进步提高了患者的预后。
研究目的
- 概述腹腔镜脾脏切除的手术协议。
- 展示与心包去血管化结合的方法。
- 改善门静脉高压患者的治疗效果。
使用的方法
- 在腹腔镜观察下进行切口和穿刺器放置。
- 使用超声和谐刀进行脾动脉结扎。
- 心包去血管化过程中胃血管的剥离和结扎。
- 术后监测并发症和恢复指标。
主要结果
- 平均手术时间约为215.63分钟。
- 记录的平均术中失血量为128.75毫升。
- 平均术后引流时间为5.5天。
- 术后住院时间平均为6.5天，并发症发生率为25%。
结论
- 腹腔镜脾脏切除联合心包去血管化是有效的。
- 患者成功完成了手术，未转为开放式手术。
- 进一步的研究可能会增进对长期结果的理解。
常见问题
Executive Industry Relevance
Laparoscopic splenectomy with pericardial devascularization addresses critical surgical needs in managing hypersplenism and esophageal variceal hemorrhage due to portal hypertension. The minimally invasive approach offers operational advantages and supports procedural standardization in complex hepatic disease models. Its reproducibility and quantifiable outputs position it as a reference technique for surgical intervention studies in translational research.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables controlled investigation of portal hypertension pathophysiology in preclinical models.
- Supports mechanistic de-risking by isolating surgical intervention effects on hematologic and vascular endpoints.
- Facilitates hypothesis testing for therapeutic modulation of splenic and portal circulation.
Screening & Assay Development
- Provides a standardized surgical protocol for reproducible induction of disease-relevant states.
- Generates quantitative outputs such as operation time, blood loss, and complication rates for comparative studies.
- Enables downstream evaluation of pharmacologic or device-based interventions in validated models.
Translational & Preclinical Research
- Aligns with disease-relevant endpoints for portal hypertension and hypersplenism.
- Supports continuity from surgical intervention to biomarker and outcome assessment in preclinical validation.
- Reduces translational ambiguity by standardizing procedural variables and postoperative monitoring.
Pipeline & Workflow Integration
This protocol integrates into the preclinical discovery-to-validation continuum for hepatic and vascular disease models.
- Discovery Biology: Enables hypothesis-driven testing of surgical and interventional strategies in portal hypertension.
- Screening: Standardizes model induction for reproducible assessment of candidate therapies.
- Analytics: Provides quantitative metrics—operation time, blood loss, complication rates—for cross-study comparison.
- Translational Research: Bridges surgical intervention with biomarker and outcome studies in disease-relevant systems.
- Enterprise Reuse: Establishes a reproducible protocol adaptable across research centers and model systems.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in surgical disease models.
- Operational Value: Enhances reproducibility, standardization, and scalability of complex surgical procedures.
- Strategic Value: Informs go/no-go decisions for interventional strategies targeting portal hypertension.
- Portfolio Impact: Supports risk-adjusted prioritization of surgical and pharmacologic candidates in hepatic disease pipelines.
Implementation Considerations
- Requires advanced surgical expertise and proficiency in laparoscopic techniques.
- Demands access to specialized instrumentation, including laparoscopes and vessel-sealing devices.
- Necessitates rigorous cross-team standardization for reproducible outcomes.
- Adaptation may be needed for different animal models or patient populations.
- Operative success and complication rates are highly dependent on operator skill, as supported by clinical practice data.
