右侧卧位腹腔镜非创伤性脾切除的临床应用

Clinical application of laparoscopic splenectomy in the right lateral decubitus

目的:介绍右侧卧位腹腔镜脾切除术(laparoscopic splenectomy,LS)的方法及脾蒂处理经验。方法:2010-01～2012-03对15例非创伤性脾切除患者采用右侧卧位腹腔镜切除,其中特发性血小板减少性紫癜8例、自身免疫性脾疾病2例、脾囊肿2例、脾梗死1例、原发性脾功能亢进2例。结果:14例全腹腔镜下完成LS,平均手术时间(140±40)min,平均失血量(120±70)ml。1例因Endo-GIA切割闭合脾蒂时操作不当造成脾静脉撕裂出血,出血约1 600 ml。脾蒂处理方法:钛夹或组织夹夹闭7例,Endo-GIA处理8例。无术后并发症发生,平均住院时间6.5 d。结论:右侧卧位腹腔镜脾切除术可提供良好的视野,便于脾蒂的处理。

Objective：To explore the approch of laparoscopic splenectomy in the right lateral decubitus and discuss the spleen pedicel handling experience.Methods： Laparoscopic splenectomy in the right lateral decubitus was performed in 15 patients from January 2010 to March 2012.They were diagnosed as idiopathic thrombocytopenic purpura（8 cases）,autoimmune spleen disease（2 cases）,splenic cyst（2 cases）,splenic infarction（1 case）,primary hypersplenism（2 cases）.Results： Splenectomy were completed under laparoscope in 14 cases with an average operation time of 140±40 min and an average blood loss volume of 120±70 ml.Hand-assisted laparoscopic splenectomy was used in one case due to uncontrolled bleeding（with a blood loss of 1600 ml） arising from the ruptured splenic vein when Endo-GIA was used to incise the closed spleen pedicel.Spleen pedicel was handled by titanic or tissue holder in 7 cases and by Endo-GIA in 8 cases.All cases recovered smoothly without postoperative complications and with a mean hospital stay of 6.5 days.Conclusion：A satisfied visual field could be exposed by laparoscopic splenectomy in the right lateral decubitus which could benefit he handling of spleen pedicel.