腹腔镜脾切除术中脾蒂处理方法的探讨

Techniques of managing spleen pedicel in laparoscopic splenectomy

目的探讨腹腔镜脾切除术(Laparoscopic Splenectomy,LS)中处理脾蒂的方法.方法回顾性分析2001年5月以来13例LS的临床资料,包括使用的不同器械和手术方法.结果 13例均获成功,手术时间平均3 h(2.0～4.5 h),术中出血10～800ml;1例巨脾,手术时间4.5 h,术中出血80 ml;3例应用LigaSure处理,手术时间平均为2.5 h,术中无出血;8例应用超声刀分离,手术时间平均3.0h,出血量10～200ml;2例应用单极电凝,手术时间约3.0 h,出血约100ml.结论术中出血是腹腔镜脾切除术失败的主要原因,脾周围韧带的分离和脾蒂的处理是腹腔镜切除术成功的关键.

Objective: To study techniques of managing spleen pedicel in laparoscopic splenectomy. Methods: 13 consecutive cases between May, 2001 and September, 2003 in department of minimally invasive surgery, Second Hospital of Hebei Medical University were analysed retrospectively, different instruments and operative methods were used for these cases. Results: The 13 cases were all succeed, the average operating time was 3 hours (2.5~4.5 hour) and average blood loss was 150 ml (10~200 ml). There is 4.5 hours operating time and 800 ml blood loss for 1 case with gigantic spleen. LigaSure was used for 3 cases, the mean operating time was 2.5 hours and no blood loss for the 3 cases. Ultrasonic shears was used for 8 cases, the mean operating time was 3.0 hours and blood loss was 10~200 ml for the 8 cases; monopole-electrocoagulation was used for 2 cases. Conclusions: Blood loss in operation is crucial reason for Laparoscopic Splenectomy failure; the approach of dealing with ligament around spleen and splenic pedicel is key in success of it.