前入路分层解剖腹腔镜原位脾切除术的临床应用

Laparoscopic splenectomy using the anterior approach with sequential layered dissection

目的 探讨前入路分层解剖腹腔镜下脾切除术（LS）的应用价值和临床疗效.方法 2007年12月至2009年7月我科共开展27例LS,回顾分析前入路分层解剖LS的临床资料.结果 除1例因胰尾肥大出血,中转剖腹行脾脏切除术外,其余手术均在腹腔镜下完成.切除脾脏长径8～20 cm,6例患者发现副脾（6/27,22.2%）,平均手术时间125 min,平均术中失血量90 ml,平均术后住院时间5.5 d.结论 前人路分层解剖可快速顺利完成LS操作,无需过多翻弄脾脏,可减少意外损伤,节约手术时间,值得临床推广应用.

Objective To study the role of laparoscopic splenectomy （LS） using the anterior approach with sequential layered dissection. Methods From December 2007 to July 2009, we performed 27 LS using the anterior approach with sequential layered dissection. The clinical data were retrospectively analyzed. Results The range of splenic length was 8-20 cm. Accessory spleen was found in 6 patients （22.2%）. The mean operative time was 125 mins. The mean intraoperative blood loss was 90 ml, and the mean postoperative stay was 5.5 days. Conclusions Laparoscopic splenectomy using the anterior approach with sequential layered dissection could be carried out smoothly and rapidly. It reduced accidental injuries and shortened the operative time.