离断脾网膜束带在腹腔镜胃癌根治术中预防脾损伤的应用  

Application of severing splenomental fold priorly to prevent iatrogenic splenic injury in laparoscopic radical gastrectomy

作　　者：陈海波 蒋英浩 施成飞 Chen Haibo;Jiang Yinghao;Shi Chengfei(Department of General Surgery,the First People′s Hospital of Wenling,Wenling 317500,China)

机构地区：[1]浙江省温岭市第一人民医院普外科,317500

出　　处：《中华全科医师杂志》2021年第5期598-601,共4页Chinese Journal of General Practitioners

摘　　要：探讨优先离断脾网膜束带在腹腔镜胃癌根治术中预防脾损伤的临床价值,对温岭市第一人民医院普外科2013年1月至2020年1月进行的521例腹腔镜胃癌根治手术的录像进行回顾分析,其中242例患者术中在分离左半大网膜或脾脏前,先离断脾网膜束带(预处理组),279例患者未先行离断脾网膜束带(对照组)。预处理组发生脾损伤4例(1.65%),其中Ⅰ级3例(1.24%)、Ⅱ级1例(0.41%);对照组发生脾损伤24例(8.60%),其中Ⅰ级22例(7.89%)、Ⅱ级2例(0.72%),牵拉脾网膜束带致脾包膜撕裂19例(6.81%)。两组脾损伤总数、Ⅰ级脾损伤及牵拉脾网膜束带致脾包膜撕裂率差异均有统计学意义(均P<0.05)。28例术中发生脾损伤者的手术时间为(185±89)min,长于493例术中无脾损伤患者的(172±95)min(P<0.05)。提示腹腔镜胃癌根治术中牵拉脾网膜束带导致脾包膜撕裂是脾损伤的主要原因,主要为Ⅰ级脾损伤,脾损伤发生会延长手术时间,优先离断脾网膜束带可有效地减少术中脾损伤。A total of 521 patients underwent laparoscopic radical gastrectomy from January 2013 to January 2020 in the First People′s Hospital of Wenling.In 242 cases the splenomental fold was severed before dissecting the left half of omentum or spleen(pretreatment group),and in 279 cases the splenomental fold was not severed priorly(routine group).For pretreatment group the introoperative splenic injury occurred in 4 cases(1.65%),including 3 cases(1.24%)with classⅠinjury and 1 case(0.41%)with classⅡinjury;while for routine group splenic injury occurred in 24 cases(8.60%),including 22 cases(7.89%)with classⅠinjury and 2 cases(0.72%)with classⅡinjury,and the rupture of splenic capsule caused by tracting splenomental fold occurred in 19 cases(6.81%).There were significant differences in total number of splenic injuries,splenic injuries with classⅠand rupture of splenic capsule caused by tracting splenomental fold between two groups(P<0.05).The operation time of 28 cases with splenic injuries was(185±89)min,which was longer than that in 493 cases without splenic injuries[(172±95)min,P<0.05].The results show that rupture of splenic capsule by tracting splenomental fold is main cause of splenic injury in laparoscopic radical gastrectomy and most of them are classⅠinjuries.To sever the splenomental fold priorly can reduce the incidence of iatrogenic splenic injury.

关 键 词：腹腔镜检查 脾网膜束带 脾损伤 手术中并发症 预防 胃切除术 根治性 

分 类 号：R735.2[医药卫生—肿瘤]