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Objective To evaluate total laparoscopic splenectomy combined with pericardial devascularization. Methods In this study,40 patients with portal hypertension and hypersplenism underwent total laparoscopic splenectomy combined with pericardial devascularization,in which 26 cases had a history of up-GI bleeding. Results Procedures were successful in 36 patients.There was four conversions to open surgery.The operations were completed in a mean time of (224 ± 54) min,with a mean estimated blood loss of (296 ± 209) ml and with no serious complication. Conclusion Total laparoscopic splenectomy combined with pericardial devascularization is a safe and effective available minimally invasive procedure in patients with portal hypertension and hypersplenism.
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ObjectiveTo study the hemodynamic changes in combined portoazygous devascularization and mesocaval shunt for treating portal hypertension and the effect of this operation. Methods100 cases of portal hypertension who received this combined operation from 1980 to 1995 were analyzed retrospectively. ResultsFree portal pressure(FPP)after shunt decreased to 1.92 kPa,which decreased portal pressure and preserved with (2.46 ± 0.30)kPa to maintain a good inflow to the liver and the encephalopathy rate was lowered. There was no death, and the effect was satisfactory. 5～15 years follow-up of 89 cases showed no rebleeding,with only 5% of encephalopathy and 15% of total mortality. Among them, 13 cases of Child C died of late-stage hepatopathy, such as liver failure, liver cancer and hepatorenal syndrome,with 94.5% of 5-year survival rate and 68.5% of 10-year survival rate. ConclusionThis combined operation is characterized by complete devascularization of sustaining varices and distal partial shunt with logical diameter. A perfect combination of both shunt and devascularization, it's one of the best choices currently available for treating portal hypertension in China.
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Objective To evalute the diagnosis and the availability of local excision for the duodenal papilla tumor(DPT).Methods The clinical data of 12 patients with DPT treated by local excision in recent 9 years were retrospectively analysed.In this series,jaundice presented in 100% of patients and always accompanied with abdminal pain.Results There was no operation death in this seties.The preoperative diagnostic rate by biopsy was 75.0%. Ten patients(83.3%)were followed up for 1-5 years,5 patients with benign tumor were survival well.Four patients with early stage T 1 DPT were still survival for 62,31,84and 36months, respectively.Conclusions The indications of local excision for DPT include benign papillary tumor smaller