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首页> 外文期刊>Surgical Endoscopy >Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage
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Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage

机译：腹腔镜脾切除术和术中脾门切除术

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摘要

Background: Intraoperative blood salvage can reduce or avoid perioperative allogeneic blood transfusion. Salvaging the blood in the portal hypertension-induced enlarged spleen becomes an issue of concern during devascularization surgery because an enlarged spleen accommodates a large red cell pool. We report 20 cases of laparoscopic splenectomy and azygoportal disconnection and present the advantages of the use of intraoperative splenic blood salvage during the procedure. Methods: A total of 20 cirrhotic patients with esophagogastric variceal bleeding refractory to treatment with β-blockers and endoscopic therapy were studied. Laparoscopic splenectomy with azygoportal disconnection was performed. During the procedure, an intraoperative autologous blood salvage device recovered the splenic blood. The perioperative data were recorded from various viewpoints. Results: The operative time was 3.1 ± 0.3 h and the blood loss was 70.5 ± 32.5 ml. The weight of the excised and morcellated spleen was 826.0 ± 155.1 g. The volume of autotransfused blood was 541.0 ± 150.4 ml. No patient received a perioperative allogeneic blood transfusion. There were no significant complications either intraoperatively or postoperatively. The hemoglobin value increased from 9.3 ± 0.8 to 11.5 ± 1.1 g/dl at postoperative day 1 (p<0.01). During a postoperative follow-up period of 18.0 ± 9.0 months for 18 patients, neither esophageal variceal bleeding nor encephalopathy recurred. Conclusion: Laparoscopic splenectomy with azygoportal disconnection is a feasible, effective, and safe surgical method for the treatment of bleeding portal hypertension. Intraoperative splenic blood salvage can avoid the risk associated with allogeneic transfusion during the procedure, with an advantage of significantly increased postoperative hemoglobin levels.
机译：背景：术中血液挽救可以减少或避免围手术期异体输血。在去血管手术中，挽救门静脉高压引起的脾肿大中的血液成为一个问题，因为脾肿大可容纳大量的红细胞。我们报告20例腹腔镜脾切除术和azygoportal断开，并提出了在手术过程中使用术中脾血液抢救的优势。方法：对20例肝硬化食管胃底静脉曲张破裂出血难治性β受体阻滞剂和内镜治疗的患者进行研究。进行了腹腔镜脾切除术，并进行了门漏连接术。在手术过程中，术中自体血液抢救装置回收了脾脏血液。从不同的角度记录围手术期的数据。结果：手术时间为3.1±0.3 h，失血量为70.5±32.5 ml。切除的脾脏的重量为826.0±155.1 g。自体输血量为541.0±150.4 ml。没有患者接受围手术期异体输血。术中或术后均无明显并发症。术后第1天的血红蛋白值从9.3±0.8增加到11.5±1.1 g / dl（p <0.01）。在18例患者的18.0±9.0个月的术后随访期间，食管静脉曲张破裂出血和脑病均未复发。结论：腹腔镜脾门切除术与门静脉切断术是治疗门脉高压性出血的一种可行，有效和安全的手术方法。术中脾脏血液挽救可以避免手术过程中同种异体输血的风险，其优点是术后血红蛋白水平显着增加。

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