Abstract: Objective To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally in? vasive and safer surgical treatment. Methods A secure splenectomy was performed with laparoscope and its supporting devices， and at the same time，the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esopha? gus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. Results Among the 14 patients，the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. Conclusion The operation of sple? nectomy plus selective pericardial devascularization under endoscope is effective，truly minimally invasive，and safe in the treat? ment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Key words: Advanced schistosomiasis； Splenomegaly； Laparoscope； Splenectomy； Selective pericardial devascularization

摘要： 目的 目的 探索晚期血吸虫病微创外科处理， 以及在贲门周围血管离断术中更安全精确、 损伤更小的方法。 方法 方法 应用腹腔镜和现代腔镜配套器械开展脾切除， 同时施行胃左静脉的胃支结扎， 以及食管旁静脉垂直进入食管壁的穿支静 脉结扎。结果 结果 14例患者均在处理脾蒂前分离脾动脉主干并夹闭。其中1例中转开腹， 原因为分离脾静脉时破裂出血所 致。无死亡病例。结论 结论 晚期血吸虫病门脉高压脾功能亢进患者经套管针 （Trocar） 腹壁孔将脾脏捣碎夹出， 无需扩大切 口取脾， 保证了真正意义上的微创。

关键词: 晚期血吸虫病； 脾肿大； 腔镜； 脾切除； 选择性贲门周围血管离断