腹腔镜脾手术110例的临床分析

The clinical analysis of laparoscopic splenic surgery:a report of 110 cases

目的：探讨腹腔镜睥手术的安全性及临床效果。方法：回顾分析110例腹腔镜睥手术的临床资料，包括107例腹腔镜脾切除术（laparoscopic splenectomy，LS），1例腹腔镜副脾切除术及2例腹腔镜睥囊肿开窗术。病例构成为原发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）55例，遗传性球形红细胞增多症（hereditary spherocytosis，HS）33例，地中海贫血（mediterranean anemia，MA）5例，肝硬化门脉高压脾亢5例，脾囊肿3例，脾脓肿1例，脾血管瘤3例，牌淋巴管瘤2例，副脾2例，脾破裂1例。结果：108例手术成功，1例因术中脾下极血管出血中转开腹，1例因术后操作孔肌层动脉出血二次手术。1例外伤性脾破裂患者急诊行LS；3例脾囊肿患者中2例行开窗术，另1例囊肿较大，行LS。手术时间1—5h，平均2，5h。手术失血20～3000ml，平均200ml。术后排气时间为48～72h，术后平均住院5d。结论：对于部分血液病及脾脏本身病变者，在严格把握适应证的情况下，腹腔镜脾脏手术是安全有效的，且具有患者创伤小、康复快等优点。

Objective： To investigate the safety and clinical effect of laparoscopic splenic surgery. Methods：The clinical data：of 110 cases of splenic surgery performed by laparoscopy,including 107 cases of laparoseopic splenectomy, 1 case of laparoscopic accesso- ry splenectomy,and 2 eases of laparoseopic splenic cyst fenestration,were analyzed retrospectively. These cases included 55 cases of ITP,33 cases of HS,5 cases of MA,5 cases of PHT with splenic function accentuation,3 cases of splenic cyst, 1 case of splenic abscess,3 cases of splenic angioma,2 cases of splenic angiolymphoma,2 cases of accessory spleen, and 1 case of splenic rupture. Results： Operations were successful in 108 cases. 1 case was c.onvered to open surgery because of the bleeding of the inferior splenic vessels, 1 case was reoperated due to the bleeding of muscular artery. Emergency LS was performed in 1 case of traumatic splenic rupture. For 3 cases of splenic cyst,fenestration were performed in 2 cases ,and LS in 1 case. The average operative time was 2.5h and mean blood loss was 200ml. The gastrointestinal movement was restored 48-72h after operation. The average postoperative .hospitalization was 5d. Conclusions：In some hematologic and splenic disease, laparoscopic splenic surgery under strict control of indications is safe and effective, with advantages of minimal invasion and rapid recovery.