手助腹腔镜行伴肝脾切除联合手术36例报告

Application of complicated combined hand-assisted laparoscopic multi-organ surgery with hepatectomy or splenectomy:with a report of 36 cases

目的:探讨手助腹腔镜用于伴肝脾切除复杂联合手术的可行性和安全性。方法:根据病灶部位和手术要求选择恰当的手助切口,为36例伴肝或脾联合病灶患者施行手助腹腔镜手术,其中肝脾联合切除4例,左肝巨大血管瘤及子宫全切除1例,巨脾及胆总管切开取石3例,改良Sugiura手术28例。结果:36例联合手术均在手助腹腔镜下获得成功,平均手术时间146min,平均出血133ml,术后无严重并发症发生,术后平均住院11.2d。结论:严格掌握手术适应证,手助腹腔镜行伴肝脾切除复杂联合手术是安全可行的,有利于减少创伤,降低手术难度,缩短手术时间,有效控制出血。

Objective： To explore the feasibility and safety of complicated combined hand-assisted laparoscopic multi-organ surgery with hepatectomy or splenectomy. Methods：The handport incision was placed appropriately accoding to multiple lesion＇ s location and operative demand. The procedures were performed through combined hand-assisted laparoscopic multi-organ surgery in 36 cases including 4 cases of combined hepatectomy with splenectomy,one case of combined hepatectomy with total hysterectomy,3 cases of combined splenectomy with choledocholithotomy and 28 cases of modified Sugiura procedure. Results：The combined laparoscopic surgery with handport were all successful. Mean operative time was 146min. Mean blood loss was 133ml. No serious postoperative complications occurred. The mean postoperative hospital stay was 11.2 days. Conclusions： HALS is feasible and safe in the complicated combined laparoscopic multi-organ surgery with hepatectomy or splenectomy for strictly selected patients. It offers significant benefits to patients such as reduced operative difficulty and trauma to the abdominal wall, shortened operative time and applied immediate hemostasis.