腹腔镜脾部分切除术的技术要点探讨  

Technique of laparoscopic partial splenectomy

作　　者：彭永海[1] 杨倩[2] 胡朝辉[1] 陈思瑞[1] 罗华[1] 

机构地区：[1]绵阳市中心医院,四川绵阳621000 [2]绵阳市中医医院

出　　处：《腹腔镜外科杂志》2016年第8期581-584,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨为脾良性占位患者行腹腔镜脾部分切除术的技术要点。方法：回顾分析2011年1月至2016年1月为15例脾良性占位患者行腹腔镜脾部分切除术的临床资料,针对脾蒂及脾局部解剖情况采取3种术式：（1）规则性脾部分切除术;（2）不规则性脾脏部分切除术;（3）规则与不规则性结合行脾脏部分切除术。结果：本组15例均成功完成手术,11例采用（1）法、3例采用（2）法、1例用（3）法。手术时间2.0-5.5 h,平均（2.5±1.2）h;术中出血量155-520 ml,平均（220.1±85.8）ml。术后病理结果提示脾脏血管瘤8例,脾脏假性囊肿4例,真性上皮性囊肿3例。术中无一例出现胰腺损伤、胃肠道损伤、大出血等并发症,无中转开腹及死亡病例,术后1例（6.7%）患者发生胰瘘。腹腔硅胶引流管放置时间除胰瘘患者外,均于3-7 d拔除,平均（4.5±2.3）d;引流管引流出的液体呈淡红色,为60-120 ml,平均（78.2±22.7）ml。结论：针对脾蒂、脾良性占位位置、局部解剖等不同情况采取不同措施,腹腔镜脾部分切除术是安全、可行的,临床疗效满意,值得临床推广应用。Objective： To investigate the technique of laparoscopic partial splenectomy in patients with splenic benign tumor.Methods： The clinical data of 15 patients of splenic space occupying lesions who underwent laparoscopic partial splenectomy from Jan.2011 to Jan. 2016 were retrospectively analyzed. Three operative methods were applied in accordance with different condition of splenic pedicle and the local anatomy. These three methods were：（ 1） the regular partial splenectomy;（ 2） the irregular partial splenectomy;（ 3） the regular partial splenectomy combined with irregularity. Results： All patients were successfully operated,there were 11 cases of method（ 1）,3 cases with method（ 2）,1 case with method（ 3）. Operative time was 2. 0-5. 5 h,the average operative time was（ 2. 5 ±1. 2） h. Intraoperative blood loss was 155-520 ml with the average of（ 220. 1 ± 85. 8） ml. Postoperative pathologic results suggested 8cases were spleen hemangioma,4 cases were pseudocyst of spleen,and 3 cases were true epithelial cyst. There was no pancreatic injury,gastrointestinal injury,hemorrhage,convertion to open surgery or mortality. Pancreatic fistula occurred in 1 case（ 6. 7%）. Except the patient with pancreatic fistula,silicone drainage tube placement time was 3-7 d,the average placing time was（ 4. 5 ± 2. 3） d. The drainage fluid appeared reddish,was about 60-120 ml with the average of（ 78. 2 ± 22. 7） ml. Conclusions： Appling different measure in accordance with different condition of splenic pedicle,splenic benign tumor,the local anatomy,laparoscopic partial splenectomy is safe and feasible with satisfying clinical effect,and is worthy of clinical popularization and application.

关 键 词：脾部分切除术 腹腔镜检查 

分 类 号：R657.6[医药卫生—外科学]