腹腔镜脾切除术26例报告

Laparoscopic Splenectomy: Report of 26 Cases

目的探讨腹腔镜脾切除的可行性和临床效果。方法 2005年10月～2011年3月施行26例腹腔镜脾切除术。超声刀离断胃结肠韧带、脾胃韧带和胃短血管,分离脾幼脉,血管夹夹闭。分离脾周粘连、脾胃韧带,并逐支分离脾叶动静脉,血管夹夹闭,离断脾蒂直至切除脾脏。离断小网膜后,超声刀或血管夹离断胃左血管及其以上所有曲张血管,完成门奇静脉断流术。将装入脾脏的标本袋从扩大的戳孔取出。结果 26例均完成LS,无中转开腹手术。手术时间70～250 min,平均142.5 min;术中出血50～3200 ml,平均262.6 ml。术后10～72 h停止胃肠减压,3～5 d拔除引流管。术后住院时间6～15d,平均7.6 d。术后未发生大出血、胰漏,并发胸腔积液3例,肺部感染1例,均经抗炎、理疗及营养支持治疗治愈。结论严格掌握手术适应证,腹腔镜下脾切除术、贲门周围血管离断术安全可行,临床效果好。

Objective To explore the feasibility and clinical outcomes of laparoscopic splenectomy（LS）.MethodsA retrospective analysis on 26 cases of laparoscopic splenectomy since October 2005 to March 2011.With ultrasonic scalper,we cut the gastrocolic ligament,gastrolienal ligament and short gastric vessels,and separated and closed the splenic artery.Afterwards,we separated the adhesive tissues surrounding the spleen and gastrolienal ligament,and closed the splenic vessels,and then disconnected the splenic pedicle and the spleen.After the minor omentum was cut,we used ultrasonic scalper or vascular clips to close the left gastric artery and other varicose vessels,so that to finish portoazygous devascularization and then remove the spleen.Results LS was completed in all the 26 cases without conversion to open surgery.The procedure was finished in 70-250 min（mean,142.5 min） with a mean of 262.6 ml of intraoperative blood loss（50-3200 ml）.Gastrointestinal decompression was stopped in 10-72 hours after the operation,and the drainage tube was withdrawn in 3-5 days.The postoperative hospital stay was 6-15 days（mean,7.6 days）.No massive hemorrhage or pancreatic leak occurred after the operation.Three patients developed pleural effusion,and one patient had pulmonary infection.All of these complications were cured by anti-inflammation,physical therapy,and nutrition support.Conclusions With the indications been controlled strictly,laparoscopic splenectomy and resection of the vessels around the cardia is feasible and safe with good clinical outcomes.