依从体位改变实现联合入路在程序化腹腔镜脾切除术中的应用  

Combined approaches to laparoscopic splenectomy following a standardized technique byoperative position changes

作　　者：宋康颉[1] 凌新建[1] 郑小超[1] 沈剑涛[1] 昝建宝[1] SONG Kang-jie;LING Xin-jian;ZHENG Xiao-chao;SHEN Jian-tao;ZAN Jian-bao.(Department of General Surgery, Anqing Hospital of Anhui Medical University, Anqing, Anhui 246003, Chin)

机构地区：[1]安徽医科大学附属安庆医院普外科,安徽安庆246003

出　　处：《肝胆胰外科杂志》2018年第3期202-206,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：安徽医科大学校临床科学基金项目(2015xkj148)

摘　　要：目的总结依从体位改变实现联合入路用于程序化腹腔镜脾切除术(LS)的效果和经验。方法回顾性分析2014年7月至2017年6月安徽医科大学附属安庆医院普外科行LS共47例患者的临床资料,手术采用两次调床,依从体位改变实现联合入路,完成程序化的三步主要操作。结果 46例患者在全腔镜下顺利完成手术,1例行辅助小切口手助完成手术。手术时间(91.49±11.96)min,术中出血(279.89±102.44)mL,未发生不可控制的大出血。术后胃肠道恢复通气时间(2.13±0.21)d,拔除引流管时间(4.77±1.52)d,术后未出现胰漏和腹腔内出血等并发症,反应性胸腔积液7例,术后住院时间(7.79±1.28)d。术后随访1～35个月,随访期间无死亡病例。结论依从体位改变实现联合入路行程序化LS成功率高,术后并发症发生率低,患者术后恢复快,易于基层医院学习掌握,值得临床推广。objective To summarize the experience of combined approaches to laparoscopic splenectomy （LS） following a standardized technique by operative position changes. Methods The clinical data of 47 patients who underwent LS in Anqing Hospital from Jul. 2014 to Jun. 2017, were retrospectively analyzed. The LS was performed by adjusting the patients＇ operative position twice, thus realizing a combined approach, as well as by using a standardized 3-step technique. Results Forty-six patients performed LS successfully, with only one patient having an additional small incision to complete the operation. Operation duration was （91.49±11.96） min. Intraoperative bleeding was （279.89±102.44） mL and no uncontrollable bleeding was found. The postoperative time of anus aerofluxus was （2.13±0.21） d. The duration of postoperative indwelling drainage catheter was （4.77±1.52） d. No pancreatic leakage or intra-abdominal hemorrhage was found, and only reactive pleural effusion was reported in 7 cases. Postoperative hospitalization length was （7.79±1.28） d. No death was found in all patients during follow-up （1 to 35 months）. Conclusion The combined approach for programmed LS has high success rate, low incidence of postsurgical complications, and short recovery time. It is a convenient and effective procedure that can be further expanded, especially in basic-level hospital.

关 键 词：腹腔镜 脾切除术 标准化程序 体位改变 联合入路 

分 类 号：R657.6[医药卫生—外科学]