二级脾蒂离断法与切割闭合器法在腹腔镜下脾切除术的临床对比研究

Clinical Comparison of Technique of Spleen Subpedicle Severance and Endo-GIA for Laparoscopic Splenectomy

【目的】探讨二级脾蒂离断法在腹腔镜脾切除术（Laparoscopic Splenectomy，LS）中的临床应用价值。【方法】回顾分析本科自2006年5月至2008年12月间31例行腹腔镜脾切除术患者（其中一级脾蒂离断法14例（A组）、二级脾蒂离断法17例（B组）的一临床资料、手术时间、术中出血量、术后并发症、住院天数及住院总费用。【结果】31例手术均获得成功，无中转开腹，两组患者术中出血量、手术时间及术后腹腔出血比较差异无显著性（P〉0．05），在术后胰漏、脾热的发生及住院天数和费用B组明显优于A组（P〈0．05）。【结论】二级脾蒂离断法安全和有效，该法并不增加手术的时间及术中的出血量，而且具有降低术后并发脾热、胰漏并发症及减少住院时间和费用的优点，具有推广价值。

[Objective] To explore the clinical value of spleen subpedicle severance for laparoscopic splenectomy. [Methods] The clinical data of 31 cases including 14 cases with the subpedicle severance （A group） and 17 cases with endo-GIA （B group） who underwent laparoscopic splenectomy in our department during May 2006 to December 2008 were analyzed retrospectively. The operation time, blood loss,operative complications, the average hospitalization stay and patient costs were observed. [Results]Laparoscopic splenectomy was successfully performed in all 31 cases. There was no conversion to open surgery. In all cases of this group, there had no significantly difference in the operation time, blood loss and leakage of ducts after operation（ P〉0. 05）. Further more, the postoperative pancreatic fistula, splenic fever, the average hospitalization stay and patient costs in B group were remarkably less than those in A group （ P〈0. 05）. [Conclusion]Technique of spleen subpedicle severance for laparoscopic splenectomy is safe and feasible,but it can not increase the operative time and blood loss. It also can reduce postoperative pancreatic fistula, splenic fever, the average hospitalization stay and patient costs. Therefore, it should be extended.