腹腔镜下三明治缝合修补技术在严重钝性脾脏外伤保脾手术中的应用  

Laparoscopic sandwich repair technique for spleen salvage after high-grade blunt splenic trauma

作　　者：林恒甫 陈盈达 林耿立 陈石池 

机构地区：[1]台湾新北市亚东医院外科部,22060 [2]台湾台北市台大医院急诊医学部,台大医学院急诊学科

出　　处：《中华创伤杂志》2014年第4期313-317,共5页Chinese Journal of Trauma

摘　　要：目的评价腹腔镜下三明治缝合技术在严重钝性脾脏破裂保脾手术治疗中的应用与效果。方法回顾性分析24例因钝性伤造成脾脏严重破裂非手术治疗失败后，接受腹腔镜下三明治缝合修补技术行止血与保脾手术患者，评价腹腔镜下三明治缝合保脾手术的技巧、手术结果、术后恢复及随访结果等。结果24例患者中，21例（88％）行腹腔镜下三明治缝合修补技术完成止血及保脾，2例因脾脏破裂伤复杂须转为腹腔镜下脾脏切除术，1例因术中血流动力学不稳定转为剖腹手术切除脾脏。止血时间（36．7±22．0）min，手术时间（136．3±40．3）min；术中失血量（1598．0±940．0）ml；住院天数（10．8±5．4）d。患者均康复出院，无死亡。随访3个月，无再出血、脾脏完全梗死、脾脏脓肿等并发症发生。结论腹腔镜下三明治缝合修补技术可有效应用于严重钝性伤患者的保脾手术。Objective To evaluate the effect of laparoscopic sandwich repair technique in spleen salvage for patients with high-grade blunt splenic trauma. Methods A retrospective study was per- formed in 24 patients with high-grade blunt splenic trauma undergone sandwich repair laparoscopically for hemostasis and spleen preservation after the failed non-operative therapy. Surgical techniques, surgical outcomes, postoperative recovery, and follow-up results were evaluated. Results Of all, 21 patients （88%） underwent laparoscopic sandwich repair for hemostasis and spleen preservation successfully; 2 were converted to the laparoseopic spleneetomy due to complex splenic rupture; 1 was converted to an open splenectomy due to unstable hemodynamics. Mean time to reach hemostasis was （36.7±22.0） minutes and operation time was （136.3±40. 3 ） minutes; mean blood loss was （1 598.0±940.0） ml and length of hospital stay was （ 10. 8±5.4 ） days. All patients were recovered at discharge. There were no complications of re-bleeding, total splenic infarction, or abdominal abscess at the 3-month follow-up. Conclusion Laparoscopie sandwich repair technique can be used effectively for spleen salvage in pa- tients with high-grade splenic trauma.

关 键 词：腹部损伤 脾 破裂 腹腔镜 

分 类 号：R657.6[医药卫生—外科学]