手助腹腔镜巨脾切除术的临床体会

The clinical experience of hand-assisted laparoscopic surgery for massive splenomegaly

目的探讨手助腹腔镜下巨脾切除术的技术要点及疗效。方法回顾性分析我院腹腔镜外科自2009年5月至2011年8月收治的216例由肝炎、血吸虫等病因导致的巨脾患者的手助腹腔镜下巨脾切除术的疗效。结果216例手术均在手助腹腔镜下顺利完成。其中平均手术时间168min，平均失血量140ml，平均术后住院时间9d，术后2例发现脾静脉血栓形成，无胰漏等并发症发生，无中转开腹。结论手助腹腔镜下巨脾切除术不仅保留了微创外科创伤小、恢复快、并发症少等优点，而且扩大了手术适应证，是一种安全有效的、相对成熟的、值得推广的微创手术方式。

Objective To explore the key points and efficiency of the hand-assisted laparoscopic surgery （HALS）for massive splenomegaly. Methods Retrospective analysis was conducted on the clinical data of 216 patients with splenomegaly from May 2009 to Aug 2011 at our laparoscopic center. The remedy and effect of HALS for massive splenomegaly caused by hepatitis, bilharziasis, etc. were reviewed. Results HALS was successfully performed in all of the 216 patients. The average operative time was 168 rain, the average intraoperative blood loss was 140 ml and the average postoperative stay was 9 d. Splenic vein thrombosis occurred in 2 cases postoperatively. No other complications such as pancreatic leakage were found. No patient required conversion to open surgery. Conclusion HALS can not only retain the charac- teristics of minimal invasion, rapid recovery and fewer complications, but also expand the surgery indications. It is a safe,effective and relatively mature surgical procedure and worth popularization.