完全腹腔镜脾切除42例临床经验总结

Experience in 42 cases of laparoscopic splenectomy

目的 探讨完全腹腔镜脾切除（laparoscopic splencetomy,LS）的手术技巧和临床经验.方法 回顾性分析杨州大学临床医学院2006年10月至2008年5月对42例施行完全腹腔镜脾切除术病人手术时间、术中失血量、术后并发症等.其中,血液病脾12例,脾结核1例,脾囊肿1例,外伤性脾破裂4例,恶性淋巴瘤1例,门脉高压性脾功能亢进症23例.脾脏装入塑料袋剪碎取出.结果 42例手术均获成功,平均出血量（300±110.60）ml,手术时间60～260 min（170±45.65）min,术后住院时间平均（8.10±3.52）d,无严重术后并发症.结论 对于大多数脾脏疾病,腹腔镜脾切除术安全可行,关键在于脾蒂的正确处理.根据脾脏的病种、大小形态、脾门等情况,选用比较适宜的脾蒂处理方案.

Objective To explore the surgical skills and clinical efficacy of laparoscopic splenectomy （LS）. Methods The operative duration, perioperative blood loss and postoperative complications were determined in 42 patients receiving LS in our hospital from October 2006 to May 2008 were retrospectively analyzed. Of the 42 patients, 12 suffered from splenomegaly due to blood disease, 1 from splenic tuberculosis, 1 from splenic cyst, 4 from traumatic splenic rupture,1 from malignant lymphoma and 23 from hypersplenism due to portal hypertension. Results LS was successfully performed in all the 42 patients. The mean perioperative blood loss was （300±110.60）ml, average operative duration （170±45.65） min （60-260 min） and mean postoperative inhospitalization duration （8.10±3.52）d. There was no severe complication after the operation. Conclusion For most types of splenic diseases, LS is safe and feasible. It is crucial to manage the splenic pedicle according to disease type, size, morphology and splenic hilus.