无蓝碟手助腹腔镜巨脾切除术15例报告

Hand-assisted Laparoscopic Splenectomy and Devascularization for Portal Hypertension: Report of 15 Cases

目的探讨无蓝碟手助腹腔镜下脾切除术的安全性和疗效。方法 2009年5月～2011年7月,完成手助腹腔镜巨脾切除15例(脾脏长径138～192 mm,平均169 mm),其中6例行贲门周围血管离断术。上腹正中5～6 cm切口,左手常规进腹,超声刀离断胃结肠韧带后,用伸入腹腔的手指在胰腺上缘将脾动脉主干游离,丝线结扎,并在手指引导下于脾蒂后方穿过吻合器钉仓,击发后离断脾蒂,然后再离断脾周围韧带,完整切除脾脏。结果 15例手术均顺利完成,手术时间76～294 min,平均147 min;出血量55～1100 ml,平均292 ml。术后住院时间7～15 d,平均9.8 d。15例随访1～25个月,平均14个月,血小板在术后18～27 d内(平均24.6 d)恢复正常,术后无远期并发症。结论无蓝碟手助腹腔镜脾切除术手术时间短,术后恢复快,并发症少,是一种值得推广的安全有效的手术方法。

Objective To evaluate the safety and efficacy of hand-assisted laparoscopic splenectomy. Methods From May 2009 to July 2011, we performed hand-assisted laparoscopic splenectomy on 15 patients with splenomegaly （ the long diameter of the spleen ranged from 138 to 192 mm with a mean of 169 mm） caused by portal hypertension, Perieardial revascularization was performed on 6 of the cases at the same time. After the gastrocolie ligament was cut,we separated and ligated the splenic artery. The loose space between the splenic hilum and renal splenic ligament was dissected with the fingers, through which a stapler was introduced and the hilum was transected before the spleen was dissociated. Results The procedure was completed successfully in all the patients, without conversion to conventional surgery. The mean operation time was 147 min （ranged from 76 to 294 min）, and mean blood loss was 292 ml （55 - 1100 ml）. The average postoperative hospital stay was 9.8 days （7 - 15 days）. The patients were followed up for a mean of 14 months （ 1 - 25 months）, during which the level of platelet recovered to a normal range in a mean of 24. 6 days （ 18 - 27 days）. No paients had long-term complications. Conclusion Hand-assisted laparoseopic splenectomy is worth being widely used because of short operation time, quick postoperative recovery and few complications.