经脐入路腹腔镜脾切除术的实验研究

Transumbilical Endoscopic Splenectomy on Porcine Model

目的探讨经脐入路腹腔镜猪脾切除术的可行性。方法6只家猪行经脐入路腹腔镜脾切除术。沿脐周缘做切口,置入3个改良的套管,分别插入2mm微型抓钳、5mm操作器械及5mm腹腔镜。微型抓钳协助牵拉、显露,超声刀游离脾周韧带,直线切割吻合器离断脾蒂。切除标本自脐部扩大的切口取出。结果6只动物均顺利完成手术。无术中出血及术后并发症发生。手术时间25～90min,(58±23)min。术中出血量10～200ml,(52±74)ml。术后1周活检见脾蒂血管夹闭牢靠,未见明显粘连、感染或脓肿形成。结论经脐入路腹腔镜下施行猪脾切除术技术上是可行的,可以达到腹壁无瘢痕的手术效果。

Objective The aim of this study was to verify the feasibility of transumbilical endoscopic splenectomy. Methods Six domestic pigs were submitted to transumbilical endoscopic splenectomy. After establishment of pneumoperitoneum,3 modified trocars （one 3 mm,two 5 mm in diameter） were placed through the infra-umbilical incisions. Dissection was performed using ultrasonic shears. The vascular pedicle was transected by an endoscopic stapler. The specimen was extracted through the enlarged umbilical incision. Results All the spleens were removed successfully in the six pigs without severe bleeding during dissection,or intraoperative and postoperative complications. The operation time was 25 to 90 minutes and decreased with experience. Postmortem examination revealed that the spleen pedicle was clipped securely, neither hemorrhage nor abscess was found at the operative field. Conclusions Transumbilical endoscopic splenectomy is feasible and safe without leaving obvious abdominal scars.