巨脾切除术的技术要点

Key points in splenectomy for massive splenomegaly

鉴于脾脏的重要生理功能日益被重视，在条件允许的情况下尽量行脾保留手术已是全球外科医师的共识。但是，对于部分脾脏疾病，脾切除术的治疗效果非其他治疗方法能及。巨脾切除中因技术差错或判断失误所致的不满意结局尚时有发生，现将巨脾切除术的相关技术总结如下。

The spleen whose size reaches or exceeds third degree should be regarded as massive splenomegaly. Spleneetomy for massive splenomegaly demands precise procedures. First, median incision on upper abdomen （or vertical rectus muscle splitting incision） and incision under left costal arch are preferred. Second, the spleen was freed and then 0. 33 mg of epinephrine was injected via the splenic artery before splenic artery ligation. During the process, a cell saver helps to minimize blood loss and makes autoinfusion possible for patients with benign lesions. Third, preoperative administration of fibrinogen, platelet and essential stypticum combined with the cooperation between surgeons and anesthesiologists are the key points of bloodless surgery which is important for the recovery of patients. Four common problems of splenectomy for massive splenomegaly should also be addressed, including operation discontinuance, perioperative hemorrhage, accessory injury and postoperative intractable fever.