腹腔镜脾切除术32例报告

Laparoscopic splenectomy: A report of 32 cases

目的探讨腹腔镜脾切除术（laparoscopic splenectomy，LS）的可行性。方法我院1999年6月-2005年12月行LS32例，超声刀游离脾周韧带，血管切割缝合器离断脾蒂，脾脏装入塑料袋剪碎取出。结果LS成功29例，手术时间60-270min，平均100min；术中出血量30-1000ml，平均230ml。术后住院3—7d，平均5d，无术后并发症。3例中转开腹，1例为脾蒂出血，1例为胃短血管出血，1例为脾周围炎粘连紧密出血。22例特发性血小板减少性紫癜中18例血小板恢复正常，4例术后无升高。2例溶血性贫血术后血红蛋白升高。4例肝炎后肝硬化合并脾功能亢进者术后血小板恢复正常。结论腹腔镜脾切除术安全可行．尤其适合于血液系统疾病中须行脾切除者及脾脏本身病变者。

Objective To investigate the feasibility of laparoscopic splenectomy （LS）. Methods Laparoscopic splenectomy was performed in 32 cases from June 1999 to December 2005 in this hospital. The splenic ligaments were disconnected using a harmonic scalpel and the pedicle of spleen was cut using the Endo-GIA system. After the spleen was mobilized, it was placed into an extraction bag, broken into small pieces, and removed from the extraction incision. Results The operation was successfully completed in 29 cases. The operation time was 60 - 270 min （ mean, 100 min） , the amount of intraoperative blood loss was 30 - 1 000 ml （mean, 230 ml） , and the length of postoperative hospital stay, 3 - 7 d （ mean, 5 d）. No postoperative complications occurred. Conversions to open surgery were needed in 3 cases because of hemorrhage of the splenic pedicle, hemorrhage of the short gastric vessels, and extensive adhesion, respectively. Of the 22 cases of idiopathic thrombocytopenic purpura （ITP） , the platelet count recovered to normal levels in 18 cases and kept unchanged in 4 cases. Of the 2 cases of hemolytic anemia, the hemoglobin levels were elevated after operation. Of the 4 cases of hypersplenism accompanying posthepatitic cirrhosis, the platelet count recovered to normal levels. Conclusions Laparoscopic splenectomy is a safe and feasible, especially for patients with hematologic diseases.