利用自然解剖间隙建立脾门后隧道在原位腹腔镜脾切除术中的临床应用  

Clinical application of the established tunnel underneath the splenic hilum via natural anatomical space to in situ laparoscopic splenectomy

作　　者：王东 陈晓鹏 戴大飞 缪化春[2] 吴锋[2] 袁权 WANG Dong;CHEN Xiaopeng;DAI Dafei;MIAO Huachun;WU Feng;YUAN Quan(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院肝胆外科,安徽芜湖241001 [2]皖南医学院解剖学教研室,安徽芜湖241002 [3]皖南医学院第一附属医院弋矶山医院医学影像中心,安徽芜湖241001

出　　处：《皖南医学院学报》2021年第2期125-128,共4页Journal of Wannan Medical College

基　　金：弋矶山医院三新项目(Y1813)。

摘　　要：目的:探讨腹腔镜脾切除术的手术技巧,评价其临床疗效及应用价值。方法:弋矶山医院外科中心在以往腹腔镜脾切除术的基础上,优化改良脾蒂处理,以脾门为标志,顺其解剖间隙贯通脾门后隧道,离断脾蒂后再原位切除脾脏。收集2018年1月~2020年1月弋矶山医院收治的23例行改良LS患者的临床资料,术前均经增强CT或MRI或CTA或三维立体重建检查评估,手术切除脾脏。分析患者手术时间、术中出血量、中转开腹率、并发症发生率和术后住院时间等,评价脾门后隧道建立的可行性及临床效果。结果:本组23例患者手术无中转开腹,均顺利完成。纳入标准同普通腹腔镜脾切除术,手术时间(105±33)min,术中出血量(90±22)mL,术后住院时间(5.6±1.8)d。所有患者术后第1天即流质饮食,1~2 d内下床活动。无腹腔出血、胰漏、感染等重大并发症,无围手术期死亡病例,效果满意。结论:利用自然解剖间隙建立脾门后隧道,优化脾蒂处理,行腹腔镜原位脾切除术安全有效,可以降低手术难度,缩短手术时间,减少手术副损伤,在临床上值得进一步推广和应用。Objective:To investigate the surgical technique for in situ laparoscopic splenectomy(LS),and evaluate its clinical effect and application value in clinical practice.Methods:Clinical data were collected in 23 patients treated with modified LS in our hospital between January of 2018 and 2020.All patients underwent either enhanced CT,MRI,CT angiography(CAT)examination or three-dimensional reconstruction of the anatomy of the spleen.Modified LS was performed by the splenic hilum,through which a tunnel was created via the natural anatomical space for in situ removal of the spleen after pedicle dissection.The feasibility of this surgical modality and its clinical effect were evaluated based on the indicators maintained in this group of patients,including the operative time,intraoperative blood loss,conversion to laparotomy,incidence of complications and postoperative hospital stay.Results:Criteria for inclusion of patients in current study were identical with those for conventional LS,and LS was completed in the 23 patients without conversion to laparotomy.The average operative time,intraoperative blood loss and postoperative hospital stay were(105±33)min,(90±22)mL and(5.6±1.8)days,respectively.Intake of liquid diet was permitted in the first day after operation,and off-bed activities occurred in day 1 or 2 following LS.No major complications,such as abdominal hemorrhage,pancreatic leakage or infection,as well as perioperative deaths occurred.The results were satisfactory.Conclusion:In situ LS on established tunnel underneath the splenic hilum via natural anatomical space basis with optimization of the splenic pedicle can greatly reduce the complexity of the operation and operative time as well as secondary injury to the adjacent organs,and is worthy of wider recommendation in clinic.

关 键 词：自然解剖间隙 脾门后隧道 优化脾蒂处理 原位腹腔镜脾切除术 

分 类 号：R657.6[医药卫生—外科学]