腹腔镜巨脾切除术

Laparoscopic splenectomy for megalosplenia

目的:探讨腹腔镜巨脾切除术的手术方法、安全性及有效性。方法:回顾分析1996年4月至2009年3月我院为72例巨脾患者行腹腔镜脾切除术的临床资料,其中38例同时行门奇静脉断流术。结果:本组70例手术均获成功,手术时间1.8～5.5h,出血60～400ml,2例中转开腹(2.7%)。2例术后腹腔出血,其中1例再次行腹腔镜探查创面止血,1例做小切口开腹止血;3例发生膈肌破裂,1例结肠脾曲破裂,4例术后发热(>38℃),1例切口血肿。术后1～5d肛门恢复排气,术后住院7～15d,平均10.5d。结论:腹腔镜巨脾切除术安全、有效,适用于脾功能亢进和巨脾患者。

Objective：To explore the methods, safety and efficacy of laparoscopie splenectomy （LS） for megalosplenia. Methods：Seventy-two patients with megalosplenia underwent LS from Apr. 1996 to Mar. 2009, among them 38 patients underwent portal azygous disconnection in the same time. Results：LS was completed successfully in 70 cases. The operative time was 1.8-5.5h, blood loss was 60-400ml. Two cases converted to open surgery （2.7%）. After operation ,two eases had abdominal hemorrhage ,one of them needed laparoscopy to stop bleeding, and the other needed open surgery to stop bleeding through small incisions. Rupture of diaphragm happened in 3 cases. Rupture of splenic flexure of colon took place in 1 case. Four cases had a fever（ T 〉 38℃ ）. One case had a blood tumor in incision. The venting time was 1-Sd after operation. The postoperative hospitalization was 7-15d, the average time was 10.5d. Conclusions：LS is safe, effective and suitable for patients with hypersplenism and megalosplenia.