腹腔镜脾切除术的技术改进

Technique Modification of Laparoscopic Splenectomy

目的 总结完全经腹腔镜行脾切除术的手术技巧。 方法 需行脾切除术的患者 2 0例 ,包括肝硬化继发性脾亢 4例 ,脾假性囊肿 1例 ,遗传性球形细胞增多症 1例 ,原发性血小板减少性紫癜 14例。采用 4孔法进腹 ,先结扎切断脾蒂 ,将脾脏放入标本袋中 ,用电动子宫旋切器切成条状分次取出。 结果 1例因大出血中转开腹 ,余 19例均成功。脾切除术操作时间平均 195 (135～ 2 70 )min。 结论 腹腔镜脾切除术安全可行、创伤小、费用不高 ,值得临床推广。

Objective To review the technical skills of laparoscopic splenectomy. Methods 20 cases underwent splenectomy, including 4 cases of hypersplenism secondary to hepatic cirrhosis, 1 case of pseudocyst of spleen, 14 cases of primary thrombocytopenic purpura. The operation processed through four port sites and the pedicle of spleen was ligated and transected first. Spleen was slided into pieces by electric uterus rotary cutter in the sample-holding bag. Results All the operation succeeded but 1 case converted to open surgery due to intraoperative uncontrollable hemorrhage. Average operation time was 195(135～270)min. Conclusions Laparoscopic splenectomy demonstrated the advantages of minimal invasion, low-cost and low-risk, should be recommended for clinical application.