腹腔镜下脾切除术56例分析  

Laparoscopic Splenectomy: Analysis of 56 Cases

作　　者：袁寅[1] 高军业 臧金锋[1] 张驰[1] 杨兴业[1] 周红兵[1] 陈曦[1] 

机构地区：[1]江苏省泰州市人民医院肝胆外科,泰州225300

出　　处：《中国微创外科杂志》2015年第2期167-169,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜下脾切除术的临床应用价值。方法 2012年8月~2013年12月完成56例腹腔镜下脾切除术。右侧垫高45°体位。常规四孔法入路,分离脾周围韧带,切割闭合或Hem-o-lok加钛夹结扎脾门血管,穿刺孔扩大成小切口取出标本;手助式腹腔镜三孔法,上腹正中取一切口置入左手,余方法同前。结果 1例因术中合并肝癌,镜下处理困难,中转开腹行肝部分切除联合脾切除术,手术时间215 min,出血520 ml。48例腹腔镜脾切除术（laparoscopic splenectomy,LS）手术时间90~160 min,（105±15）min;术中出血40~550 ml,（90±38）ml;引流管拔除时间术后4~12 d,（4.2±1.6）d;住院5~15 d,（5.7±2.1）d。7例手助腹腔镜下脾切除术（hand assisted laparoscopic splenectomy,HALS）手术时间80~140min,（95±20）min;术中出血200~600 ml,（110±91）ml;引流管拔除时间术后2~6 d,（3.6±1.3）d;住院4~8 d,（4.8±1.5）d。1例术后门静脉血栓,1例术后轻度胰漏,对症处理后好转出院。56例随访6个月,无死亡,无术后肝功能衰竭、感染等。结论腹腔镜下脾切除术操作简便,在手术技术熟练的情况下能安全有效的适用于各种脾脏疾病。Objective To evaluate the clinical value of laparoscopic splenectomy. Methods Clinical data of 56 patients who had undergone laparoscopic splenectomy between August 2012 and December 2013 were analyzed. The patients were placed at an elevated 45° to the right position. By using conventional four-trocar method,the ligaments around the spleen were separated,cut,and closed,or the splenic vascular vessels were ligated with Hem-o-lok,and then one of puncture holes was expended into a small incision to extract the specimen. By using hand-assisted laparoscopic approach,three-trocar method was utilized with introduction of left hand through a 5 cm abdominal incision. Results There was 1 case of conversion to open surgery because of hepatocellular carcinoma found in operation,which was given partial hepatectomy combined with splenectomy,with an operation time of 215 min and a blood loss of 520 ml. There were 48 cases of laparoscopic splenectomy. The operation time was 90- 160 min（ 105 ± 15 min）,the intraoperative blood loss was 40- 550 ml（ 90 ± 38 ml）,the length of hospital stay was 5- 15 d（ mean,5. 7 d）,and drainage time was 4- 12 d（ 4. 2 ± 1. 6 d）. There were 7 cases of hand assisted laparoscopic splenectomy. The length of hospital stay was 4- 8 d（ mean,4. 8 d）,the operation time was 80- 140 min（ 95 ± 20 min）,the intraoperative blood loss was 200- 600 ml（ 110 ± 91 ml）,and the drainage time after surgery was 2- 6 d（ 3. 6 ± 1. 3 d）. There were 1 case of postoperative portal vein thrombosis and 1 case of mild pancreatic leakage,all of which were cured after symptomatic treatment. Follow-up examinations in 56 cases for 6 months found no hospital deaths and no postoperative liver failure or infection. Conclusion Laparoscopic splenectomy is suitable for a variety of spleen diseases.

关 键 词：腹腔镜脾切除术 手助腹腔镜脾切除术 

分 类 号：R657.6[医药卫生—外科学]