腹腔镜脾切除术中的操作与显露

Technique and exposure of laparoscopic splenectomy.

目的 探讨腹腔镜脾切除术 (LaparoscopicSplenectomy ,LS)手术操作和术野显露。 方法回顾分析 1999年 6月以来 11例LS临床资料 ,包括 1例肝硬化脾功能亢进和 10例原发性血小板减少性紫癜 (IdiopathicThrombocytopenicPurpura ,ITP)。 结果 9例获得成功 ,其中 6例采取仰卧位 ,手术时间平均 3 5小时 ,术中出血平均 2 0 0ml;1例采取右侧卧位 ,手术时间 4小时 ,术中出血 80ml;2例采取右侧斜卧位 ,手术时间分别为 2 5小时和 3 0小时 ,术中出血均为 10 0ml。 1例ITP术后 6小时出现腹腔内出血而再次剖腹手术 ,2例ITP中转开腹。 结论 脾周韧带及组织的良好显露与分离和脾蒂的成功控制是腹腔镜脾切除术成功的关键。

Objective To study the operative technique and operative field exposure of laparoscopic splenectomy (LS). Methods The clinical data of 11 cases including 1 case of cirrhosis with splenosis and 10 cases of idiopathic thrombocytopenic purpura (ITP) who underwent laparoscopic splenectomy since June 1999 were analyzed retrospectively. Results 9 cases of LS were successfully performed. 6 cases took dorsal desubitus position, whose mean operative time was 3.5 hours and mean blood loss was 200ml. The operative time of the case who took right lateral desubitus position was 4 hours and the blood loss was 80ml. 2 cases took right inclined lateral desubitus position, and the operative time was 2.5 hours and 3.0 hours and the blood loss all was 100ml. 1 ITP patient of the 9 cases underwent novo-laparotomy in 6 hours after LS because of intraabdominal hemorrhage. 2 ITP cases required conversion into open splenectomy. Conclusions Satisfactory exposure and dissection of peri-splenic ligaments and constitution as well as successful control of splenic pedicel are the