腹腔镜脾切除联合胆囊切除术技术探讨

Experiences and surgical techniques of laparoscopic splenectomy combined with cholecystectomy

目的探讨腹腔镜下脾脏联合胆囊切除（LS＋LC）的手术技术以及临床应用指征。方法回顾性分析2例腹腔镜脾切除联合胆囊切除患者的临床资料。结果2例患者均在腹腔镜下完成脾切除联合胆囊切除手术，其中脾切除手术时间分别为90和100min，出血量分别为700和800ml；术后恢复顺利，无出血、感染、胰漏等并发症发生，均于术后第5天出院。结论LS＋LC手术过程中脾蒂处理是手术成功的关键，应根据脾门血管的解剖类型选择适当的处理方法；临床应用指征建议仅选择非急性炎症胆囊结石合并脾脏疾病患者，并在手术过程中注意无菌技术和手术顺序。

Objective To explore the surgical techniques and clinical indication of laparoscopic splenectomy combined with cholecystectomy. Methods The clinical data from two patients underwent laparoscopic splenectomy combined with cholecystectomy were retrospectively analyzed. Results Two patients have been performed splenecto- my with cholecystectomy successfully under laparoscopy. The operation time of laparoscopic splenectomy was 90 min and 100min. Blood loss was 700ml and 800ml. Two patients were discharged 5 days postoperatively withoul： any com- plications of bleeding,infection, pancreatic leakage. Conclusion The key surgical technique in the laparoscopic sple- nectomy combined with cholecystectomy was to control the splenic artery and vein according to different spleen anato- my. Non-acute inflammatory gallstone with surgical splenic diseases was considered the clinical indications and the a- septic techniques and the sequence should be taken seriously during LS ＋ LC.