腹腔镜脾切除术中不同脾蒂离断法的选择与应用  

The selection and application of laparoscopic splenectomy by different pedicle division strategies

作　　者：汤建军[1] 孙姚承 法镇中[1] 张伟元[1] 闵震宇[1] 吴杰 奚剑波[1] TANG Jian-jun;SUN Yao-cheng;FA Zhen-zhong;ZHANG Wei-yuan;MIN Zhen-yu;WU Jie;XI Jian-bo(De-partment of General Surgery,Wujin Affliated Hospital of Jiangsu University,Changzhou,Jiangsu 213000,China)

机构地区：[1]江苏大学附属武进医院普外科,江苏常州213000

出　　处：《肝胆胰外科杂志》2018年第6期462-466,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：武进科技发展项目(WS201611)

摘　　要：目的探讨腹腔镜脾切除术中二级脾蒂离断法(laparoscopic splenectomy by secondary pedicledivision,LSSP)和一级脾蒂离断法即直线切割器离断(laparoscopic splenectomy by Endo-GIA division,LSED)的选择及临床应用价值。方法回顾性分析江苏大学附属武进医院2013年3月至2017年12月31例行腹腔镜脾切除术患者的临床资料,其中LSSP组12例,LSSD组19例。结果 31例患者手术均成功完成。LSSP组的手术成功率、术中出血量、手术时间、肠鸣音恢复时间、平均排气时间、术后禁食时间、术后镇痛药使用率、术后住院时间分别为100%、(101.6±21.4)mL、(134.1±25.9)min、(28.2±2.5)h、(35.5±3.4)h、(2.9±0.7)d、25.00%和(10.2±0.5)d,与LSED组100%、(98.9±24.6)mL、(123.8±27.1)min、(30.3±2.2)h、(36.4±2.7)h、(3.1±0.6)d、26.32%和(10.5±0.4)d相比均无统计学差异(P> 0.05)。LSSP组的并发症发生率、手术费用分别为16.67%、(35 821.6±621.3)元,与LSED组的36.84%、(42 715.9±714.6)元相比差异有统计学意义(P <0.05)。结论 LSSP较LSED具有手术费用低、并发症发生率低等优点,但操作过程相对复杂,技术要求高,需要手术者有较丰富的经验。因此针对行腹腔镜脾切除术的患者,术前、术中要进行要正确评估,结合脾脏大小、脾门血管情况,手术者经验、擅长或偏好的手术方式,患者需求意愿和医院配置等多因素综合分析,手术过程中灵活选择不同脾蒂离断法,尽可能为患者提供最合适的术式。Objective To explore the selection and application of laparoscopic splenectomy by secondary pedicle division （LSSP） or by Endo-GIA division （LSED）. Methods From Mar. 2013 to Dec. 2017, 31 patients were underwent laparoscopic splenectomy in Wujin Affliated Hospital of Jiangsu University, including 12 cases in LSSP group and 19 cases in LSED group. Results Laparoscopic splenectomy was successfully performed in 31 patients. The operation success rate, intraoperative blood loss, operation time, intestinal sound recovery time, average exhaust time, postoperative fasting time, postoperative analgesic use rate, postoperative hospitalization time of LSSP group were 100%, （101.6±21.4）mL, （134.1±25.9）min, （28.2±2.5）h, （35.5±3.4）h, （2.9±0.7）d, 25.00% and （10.2±0.5）d, while LSED group were 100%, （98.9±24.6）mL, （123.8±27.1）min, （30.3±2.2）h, （36.4±2.7）h, （3.1±0.6）d, 26.32% and （10.5±0.2）d, there was no statistically signifcant difference （P〉0.05）. But the incidence of complications and surgical costs in the LSSP group were 16.67% and （35 821.6±621.3）yuan, which were significantly different from 36.84% and （42 715.9±714.6）yuan in the LSED group （P〈0.05）. Conclusion Compared with LESD, LSSP has the advantages of lower cost and lower incidence of complications,but the operation process is relatively complicated, the technical requirements are high, and surgeons are required to have more experience. Therefore, for patients undergoing laparoscopic splenectomy, the correct assessment must be performed before and during operation, combining the size of the spleen, the splenic portal vascular condition, and the experience, expertise, or preference of the surgeon. Multiple factors such as patient＇s demand intention and hospital confguration are needed to analyze, and then provide the most suitable surgical protocol for patients.

关 键 词：腹腔镜 脾切除 脾蒂 

分 类 号：R657.6[医药卫生—外科学]