腹腔镜巨脾切除中转开腹手术原因分析

Analysis of reasons for conversion to laparotomy in laparoscopic megalosplenia resection

目的:探讨腹腔镜巨脾切除术中转开腹的原因及预防措施。方法:回顾分析2006年9月至2009年8月为38例巨脾患者施行腹腔镜脾脏手术的临床资料,其中8例中转开腹。结果:30例成功施行腹腔镜巨脾切除术,术中出血50～1200ml。8例中转开腹,主要原因为出血,器械因素,脾脏呈球形肿大,脾门如脐状凹陷,处理脾蒂困难及病程较长。结论:通过改进手术方式,术中仔细操作,中转开腹的某些因素是可避免的,能明显降低中转开腹率。绝大部分巨脾手术可通过腹腔镜手术完成。

Objective：To investigate the causes and preventive measures of conversion to laparotomy in laparoscopic megalosplenia resection.Methods：The clinical data of 38 megalosplenia patients who underwent laparoscopic splenectomy from Sep.2006 to Aug.2009 were retrospectively analyzed.8 cases were converted to laparotomy.Results：Thirty cases of laparoscopic megalosplenia resection were successful,and the operative blood loss was 50-1 200ml.The reasons for the 8 cases of conversion to laparotomy included hemorrhage,instruments,globular swelling spleen,umbilication of spleen hilum,difficult dealt splenic pedicle and long pathogenesis.Conclusions：Some reasons which would result in conversion to open surgery could be avoided through improved operative method and careful operation,and the conversion rate can be obviously decreased.Most megalosplenia operations could be completed by laparoscopic operation.