脾蒂先离断技术手助的腹腔镜脾切除与断流术30例  

Hand-assisted laparoscopic splenectomy and devascularization for porta hypertension by hilum-first approach 30 cases

作　　者：忻颖[1] 朱江帆[1] 戴国清[1] 马颖璋[1] 徐安安[1] 

机构地区：[1]同济大学附属东方医院普外科,上海200120

出　　处：《中华腔镜外科杂志（电子版）》2013年第1期15-17,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的总结脾蒂先离断技术行手助的腹腔镜脾切除与断流术的经验。方法 2006年8月至2012年9月,用脾蒂先离断技术完成手助腹腔镜巨脾切除30例。其中21例同时行贲门周围血管离断术。离断胃结肠韧带后,用伸入腹腔的手指分离脾蒂与其外侧腹膜之间的疏松组织,穿过脾蒂下方后,在手指引导下于脾蒂后方穿过吻合器钉座,击发后离断脾蒂。然后再离断脾周围韧带,完整切除脾脏。结果所有手术均顺利完成,无中转开腹手术。手术时间85～240min,平均(152.0±39.9)min。术中出血量50～600ml,平均(263.8±161.2)ml。8例术中输血300～600ml,22例术中未予输血。无中转开腹手术。手术并发症包括术后出血1例,腹膜后血肿1例。26病例获电话随访,随访时间1～72个月,平均31个月。1例术后5年发生再次出血,死于原发性肝癌;1例死于肝功能衰竭。结论脾蒂先离断技术行手助腹腔镜脾切除与断流术可以增加手术安全性,缩短手术时间,减少术后并发症发生机会。Objective To summarize the experience of hilum-first approach in hand-assisted laparoscopic splenectomy for patients with splenomegaly. Methods From August 2006 to September 2012, thirty cases of hand-assisted laparoscopic splenectomy were performed by hilum first approaches among which 21 cases of peri-esophagus devascularization was performed at the same time. The loose space between splenic hilum and renal-splenic ligament was dissected with the fingers, through which a stapler was introduced and the splenic hilum was transected before dissociating the spleen. Results All the procedures were completed successfully without conversion to conventional surgery. The mean operative time was ( 152.0 ± 39.9 )min, average 85 - 240 min, and mean blood loss was ( 263.8 ± 161.2 )ml, range 50 - 600 ml. Intraoperative blood infusion was necessary only in 8 cases. Operative complications included one case of abdominal bleeding and another case of retroperitoneal haematoma. A mean of 31 months ( 1 - 72 months ) telephone follow-up was achieved in 26 cases. During the follow-up period, one patient showed hemorrhage from esophageal varicesand died of primary hepatocellular carcinoma. One patient died of liver failure. Conclusions Hilum-first approach in hand-assisted laparoscopic splenectomy may effectively decrease operation time and postoperative complications, and increase surgical safety.

关 键 词：腹腔镜 手助 脾切除 肝硬变 门脉高压 

分 类 号：R657.6[医药卫生—外科学]