手助腹腔镜技术在复杂肝脾外科手术中的应用:附202例报告

Application of hand-assisted laparoscopic surgery in complicated surgery of liver and spleen:a report of 202 cases

目的探讨手助腹腔镜技术在复杂肝脾外科手术中的应用价值。方法对202例肝或脾外科疾病进行手助腹腔镜手术,包括肝切除94例,脾切除29例,改良Sugiura术28例,肝脾联合切除4例,肝子宫联合切除1例,肝切除加胆总管取石术41例,脾切除加胆总管取石术5例。结果202例手助腹腔镜手术均获得成功。平均手术时间为(138±12)min,平均出血量(179±34)mL,术后无严重并发症发生。全组无死亡。术后平均住院(9.2±1.1)d。结论在严格掌握适应证的前提下,应用手助腹腔镜技术行复杂肝脾外科手术是安全可行的,有减少创伤,降低手术难度,缩短手术时间,有效控制出血等优点。

Objective To explore the feasibility and safety of hand-assisted laparoscopic surgery （ HALS ） in complicated liver and spleen surgery. Methods HALS was used in 202 cases including 94 cases of hepatectomy, 29 cases of splenectomy, 28 cases of modified Sugiura procedure, 4 cases of combined hepatectomy and splenectomy, 41 cases of combined hepatectomy and choledochotithotomy, one case of combined hepatectomy and total hysterectomy and 5 cases of combined splenectomy with choledocholithotomy. Results HALS was successful in all of the 202 cases. Mean surgical time was （ 138 ±12 ） minutes. Mean blood loss was （ 179 ± 34 ） mL. No serious postoperative complications occurred. The mean postoperative hospital stay was （ 9. 2 ± 1. 1 ） days. Conclusions HALS is feasible and safe in complicatedliver and spleen surgery for strictly selected patients. It offers to patients significant benefits such as decreased operative difficulty and trauma to the abdominal wall, shortened operative time, and effective control of hemorrhage.