免辅助装置手助腹腔镜巨脾切除及同步脾血回输的临床研究  

Clinical study of free auxiliary device of hand assisted laparoscopic splenectomy and intraoperative autologous splenic blood transfusion

作　　者：邓小荣[1] 彭七华 赵艳平[3] 姜进平[3] 林云 罗翠松 

机构地区：[1]广东医学院附属南山医院胃肠外科,深圳518052 [2]广东医学院附属南山医院麻醉科,深圳518052 [3]南昌大学第一附属医院普外科 [4]江西省新余市人民医院普外科

出　　处：《中华实验外科杂志》2013年第12期2701-2703,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨免辅助装置手助腹腔镜巨脾切除的可行性、技术优势以及术中同步脾血回输的临床价值.方法 分析自2007年10月至2011年10月间行巨脾切除的肝硬化门脉高压症48例患者的临床资料,按手术方式分免辅助装置的手助腹腔镜组（n=30）、完全腹腔镜组（n=12）,另6例为中转手助或开腹手术.比较术中出血、手术时间与取脾时间;按脾脏长径（＞ 20 em或≤20 cm）分为重度脾肿大（n=28）与中度脾肿大（n=20）,比较两者的术中出血及中转手术率.采用血液回输机进行同步脾血回输.结果 免辅助装置不影响手术中气腹的保持,平均每例患者节省费用约2000元.手助腹腔镜组与完全腹腔镜组的平均出血量差异无统计学意义[（88.1±16.3） ml比（107.5±11.6）ml,P＞0.05];手助腹腔镜组平均手术时间明显短于完全腹腔镜组[（75.2±13.3） min比（120.7±20.5）min,P＜0.05];手助腹腔镜组平均取脾时间明显短于完全腹腔镜组[（8.0±3.1） min比（25.2±2.8）min,P＜0.05）.重度脾肿大患者的手术中转率（50％）显著高于中度脾肿大患者（20％,P＜0.01）;术中出血明显高于中度脾肿大患者[（103.8±25.0） ml比（70.4±10.3） ml,P＜0.01].术后第1天,同步睥血回输的患者血红蛋白较术前显著升高[（2.07±0.25） g/L,P＜0.05].结论 手助腹腔镜巨脾切除术具有较强的安全性与可行性,尤其对于重度脾肿大患者显示明显优势;免辅助装置有效而经济;同步脾血回输明显提高患者血红蛋白水平.Objective To investigate the feasibility and advantage of hand assisted laparoscopic splenectomy for giant spleens without auxiliary device and the clinical value of intraoperative autologous splenic blood transfusion.Methods From October 2007 to October 2011,48 cases of liver cirrhosis splenomegaly were analyzed retrospectively according to operation method including hand assisted laparoscopic splenectomy group with free auxiliary device （HALS） （n =30） and conventional laparoscopic splenectomy （CLS） （n =12）,and they were divided into two groups：severe splenomegaly group （the length of the spleen more than 20 cm） and moderate splenomegaly （the length of the spleen less than 20 cm）.The intraoperative bleeding,operation time,the spleen removal time and transit operation rate were compared in these patients.The blood transfusion machine was used for autologous splenic blood transfusion.Results Free auxiliary device saved at least 2000 yuan without affecting the maintenance of pneumoperitoneum during operation.There was no significant difference in the average blood loss between HALS group and CLS group [（88.1 ± 16.3） ml vs.（107.5 ± 11.6） ml,P ＞0.05].The average operation time was significantly shorter [（75.2 ± 13.3） min vs.（120.7 ± 20.5） min,P ＜ 0.05],and the spleen removal time was markedly shorter [（8.0 ±3.1） min vs.（25.2 ±2.8） min,P ＜0.05] in HALS group than in CLS group.The transit operation rate of severe splenomegaly （50％） was significantly higher than moderate splenomegaly （20％） （P ＜ 0.01）,and the intraoperative bleeding too [（103.8 ± 25.0） ml vs.（70.4 ± 10.3） ml,P ＜0.01].Intraoperative autologous splenic blood transfusion significantly elevatedf hemoglobin level on the first day after operation [（2.07 ± 0.25） g/L,P ＜ 0.05].Conclusion HALS significantly facilitates the surgical procedure and reduces the operational risk,while maintaining the advantages of CLS.Hand-assisted laparoscopic splenectomy is a safe and

关 键 词：腹腔镜 手助 巨脾症 脾血回输 

分 类 号：R657.6[医药卫生—外科学]