腹腔镜下脾门血管精细解剖+超声刀钳夹法在脾部分切除术中的应用  

The application of splenic vascular meticulous anatomical plus harmonics scalpel clamping method in laparoscopic partial splenectomy

作　　者：李毅[1] LI Yi(Department of Hepatobiliary and Pancreatic Surgery,Deyang People s Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院,四川德阳618000

出　　处：《腹腔镜外科杂志》2019年第4期263-266,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨脾门血管精细解剖+超声刀钳夹法应用于腹腔镜脾脏部分切除术中的可行性与安全性。方法:2013年3月至2016年12月为17例患者行腹腔镜脾部分切除术,包括外伤性脾破裂11例,脾脏良性肿瘤6例(脾脏错构瘤2例,脾脏血管瘤1例,脾脏淋巴管瘤1例,脾囊肿1例,脾脏炎性肉芽肿1例)。记录手术时间、术中出血量、术后并发症等。结果:16例患者顺利完成手术,1例改为腹腔镜脾切除术,手术时间平均(85.2±45.3)min;术中出血量平均(285.5±67.0)mL;术后引流2～5 d,平均(3.0±1.2)d,引流量10～290 mL,平均(50.7±36.4)mL。术后均无活动性出血、腹腔感染、切口感染等并发症发生。术后1周行增强CT,见保留血管支通畅,脾周少量积液,脾脏边缘少部分缺血坏死,无脾脓肿、脾周脓肿形成,所保留的脾脏与术前相比有血供的区域大于30%。术后随访22个月,残余脾脏血供良好,白细胞、血小板计数正常。结论:腹腔镜脾部分切除术中应用脾门血管精细解剖+超声刀钳夹法安全、可行。Objective: To explore the feasibility and safety of splenic vascular meticulous anatomical combined harmonics scalpel clamping method in laparoscopic partial splenectomy. Methods: From Mar.2013 to Dec.2016,a total of 17 patients underwent laparoscopic partial splenectomy,including 11 cases of traumatic spleen rupture and 6 cases of benign spleen tumors (2 spleen hamartomas,1 spleen hemangioma,1 spleen lymphangioma,1 spleen cyst and 1 spleen inflammatory granuloma).The operation time,intraoperative blood loss and postoperative complications were observed. Results: Sixteen patients underwent laparoscopic partial spleen resection and 1 patient changed to laparoscopic splenectomy.The operation time was (85.2±45.3)min.The intraoperative blood loss was (285.5±67.0)mL.The postoperative drainage was 2-5 d with an average of (3.0±1.2)d.No complications such as active bleeding,abdominal infection or incision infection occurred.The results of contrast-enhanced CT one week after operation showed that the vascular branches were unobstructed and the spleen remained more than 30% area with good blood supply.Only a small amount of effusion was found around the spleen and a few ischemic necrosis was at the splenic margin.No spleen or peri-splenic abscess formed.During the follow-up of 22 months,the blood supply of residual spleen was satisfactory,the WBC and platelet count was normal. Conclusions: Splenic vascular meticulous anatomical combined harmonic scalpel clamping method in laparoscopic partial splenectomy is feasible and safe.

关 键 词：脾部分切除术 腹腔镜检查 脾门解剖 超声刀钳夹法 

分 类 号：R657.6[医药卫生—外科学]