探讨脾动脉先行的五步法腹腔镜脾切除术（LS）治疗肝硬化门静脉高压症巨脾患者的安全性和疗效。

回顾性分析2017年9月至2019年9月中山大学附属第三医院岭南医院收治的11例行脾动脉先行的五步法LS治疗门静脉高压症巨脾患者临床资料。其中男8例，女3例；平均年龄（41±10）岁；脾脏长径≥20 cm。患者均行脾动脉先行的五步法LS，术中优先结扎脾动脉，经脾蒂上缘间隙充分游离出脾蒂，离断脾蒂后再处理脾上极的胃短血管。观察患者围手术期情况。

患者均顺利完成脾动脉先行的五步法LS，术中无中转开腹。手术时间（275±47）min，术中出血量（315±85）ml，术后进食时间（2.9±1.4）d，术后住院时间（11±4）d。无围手术期死亡，无术后发热、胸腔积液等并发症。

对于肝硬化门静脉高压症巨脾患者，脾动脉先行的五步法LS优化了脾切除手术流程，是一种简单、安全、有效的方法。

To evaluate the safety and efficacy of five-step laparoscopic splenectomy (LS) with splenic artery ligation first for massive splenomegaly secondary to portal hypertension and liver cirrhosis.

Clinical data of 11 patients with portal hypertensive splenomegaly undergoing LS with splenic artery ligation first in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to September 2019 were retrospectively analyzed. Among them, 8 patients were male and 3 female, aged (41±10) years on average. The length of spleen was measured ≥20 cm. All patients underwent five-step LS with splenic artery ligation first. The splenic pedicle was totally dissected through the space between the upper margins of splenic pedicle. After the splenic pedicle was severed, the short gastric vessels at the upper pole of spleen were treated. Perioperative conditions of the patients were observed.

All patients successfully completed the five-step LS with splenic artery ligation first, and no patients were converted to open surgery during operation. The operation time was (275±47) min, intraoperative blood loss was (315±85) ml, postoperative food intake time was (2.9±1.4) d, and postoperative length of hospital stay was (11±4) d. No perioperative death, postoperative fever, pleural effusion or other complications occurred.

For patients with liver cirrhosis and portal hypertensive splenomegaly, five-step LS with splenic artery ligation first is a convenient, safe and efficacious operation, which optimizes the procedures of splenectomy.