脾蒂优先处理法在腹腔镜巨脾切除术中的临床应用  

Clincal Application of Prior Treatment of Splenic Pedicle in Laparoscopic Splenectomy for Splenomegaly

作　　者：黎东伟 李君久 熊秋华 张慧嫦 莫大超 孙达 欧阳君 Li Dongwei;Li Junjiu;Xiong Qiuhua(Department of General Surgery, Tungwah Hospital Affiliated to Sun Yet-sen University, Dongguan 523110, China)

机构地区：[1]中山大学附属东华医院普外科,东莞523110

出　　处：《中国微创外科杂志》2018年第3期230-232,240,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨脾蒂优先处理法在腹腔镜巨脾切除术中的价值。方法 2013年1月~2015年12月我科行全腹腔镜巨脾切除术23例,均采用脾蒂优先处理法切脾,即初步切开脾胃韧带显露脾门后,切开脾蒂下缘与脾脏之间的腹膜,建立脾门后隧道,利用直线型切割闭合器通过隧道切割闭合离断脾蒂,再依次离断各脾周韧带以切除脾脏。结果 23例均顺利完成手术,无中转开放手术,无围手术期死亡。手术时间125~235 min,(196.6±34.1)min;术中出血量200~800 ml,(325.6±104.5)ml;术后下床时间1~4 d,(2.3±0.5)d;排气时间1~3 d,(2.2±0.6)d;术后住院7~20 d,(11.4±3.3)d。术后2例感染,9例腹水,无胰漏、术后出血、肝功能衰竭等并发症发生。20例随访1~4年,(2.8±0.9)年,无死亡。结论脾蒂优先处理法可降低腹腔镜巨脾切除术的难度,简化手术,值得进一步推广。Objective To study the clinical value of prior treatment of splenic pedicle in laparoscopic splenectomy for splenomegaly.Methods Twenty-three patients with splenomegaly in our hospital from January2013to September2015were retrospectively analyzed,which all underwent laparoscopic splenectomy with prior treatment of splenic pedicle.After the initial incision of the spleen and stomach ligament to expose the spleen pedicle,the peritoneum between the spleen and the lower edge of spleen pedicle was cut open,then a tunnel behind the spleen pedicle was established.The spleen pedicle was closed off by Endo-GIA through the tunnel,then the splenic ligaments were removed successively in order to remove the spleen.Results The laparoscopic procedures were performed successfully in all the cases and no procedure was converted to open surgery.No one died in the perioperative period.The operation time was125-235min(mean,196.6±34.1min),the blood loss was200-800ml(mean,325.6±104.5ml),the active time post-operation was1-4d(mean,2.3±0.5d),the flatus time was1-3d(mean,2.2土0.6d),and the postoperative hospital stay was7-20d(mean,11.4±3.3d).Infection occurred in2cases and there were9cases of different degrees of ascites.No other complication occurred such as pancreatic fistula,postoperative hemorrhage or liver failure.Conclusions Prior treatment of splenic pedicle in laparoscopic splenectomy for splenomegaly can reduce the difficulty of operation and simplify the operation.It is worthy of further popularization.

关 键 词：腹腔镜脾切除 脾蒂 巨脾 

分 类 号：R657.6[医药卫生—外科学]