腹腔镜脾切除术63例

Clinical study of laparoscopic splenectomy in 63 patients

目的总结腹腔镜脾切除术的经验和探讨其临床应用价值。方法回顾性分析自1995年开展腹腔镜脾切除术以来所有脾切除术患者的临床资料。将63位患者的相关资料分为6组，比较它们的手术时间、手术中出血量、术后住院天数、术后开始流食天数、术后引流管拔出天数、术后4d内引流量、手术后并发症和手术适应证。结果63例患者的平均年龄为44．19岁，身体质量指数平均为23．75；中转开腹3例，2003年后开展的53例在患者手术时间、手术中出血量、术后住院天数、术后开始流食天数、手术后并发症、中转开腹率等方面好于2003年前开展的10例。2003年前手术适应证限于与脾脏相关性血液系统疾病，2003年后适应证范围明显扩大，以治疗脾脏肿瘤为主。结论腹腔镜脾切除手术存在明显的学习曲线变化趋势，经历10例手术后进入并一直保持在手术平台期。在严格掌握适应证下，腹腔镜脾切除术是安全、有效、可行的，腹腔镜脾切除不仅适用于脾脏相关性血液系统疾病，也适用于脾脏肿瘤性疾病。

Objective To explore the clinical application of laparoscopie spleneetomy in treatment of spleen disease at our hospital. Methods We reviewed laparoscopie spleneetomy carried out at our hospital since 1995, patients were grouped by date. 63 laparoseopic splenectomies were divided into six groups. Operation time, intraoperative blood loss, postoperative hospital stay, time to feeding, days of drainage, amount of drainage, postoperative complications and indications for surgery were compared. Results Patient＇s age averaged at 44. 19 years, body mass index averaged at 23.75, 3 patients were converted to open surgery. Mean operating time, blood loss, postoperative hospital stay, time to feeding, converting rate in the 53 cases which had the surgery after 2003 were much better than the 10 cases before 2003. Surgical indications for laparoscopie spleneetomy were limited to hematopoietic disease related splemegaly before 2003, the indication range significantly expanded after 2003, during which laparoscopic splenectomy were mainly applied to treat spleen tumors. Conclusions There is a marked learning curve in laparoscopie splenectomy after 10 surgeries before 2003 we have achieved the level. With the suitable approach, apparatus and skillful technique, laparoscopie spleneetomy is safe and feasible to treat tumors of the spleen.