腹腔镜脾脏部分切除术(附6例报告)

Laparoscopic Partial Splenectomy: Report of 6 Cases

目的探讨腹腔镜脾脏部分切除术的可行性和安全性。方法 2008年4月～2012年11月,对6例CT或MRI检查明确诊断为脾脏囊性病变施行腹腔镜脾脏部分切除术,肿物最大径5.3～17.2 cm,平均8.9 cm,位于上极1例,中上极1例,下极4例。经脐孔穿刺建立气腹,于脾门处游离并切断脾脏上极或下极血管,沿缺血线行规则性脾部分切除术。结果 6例均在腹腔镜下完成手术,手术时间175～325 min,平均230.8 min;术中出血量50～700 ml,中位出血量150 ml。脾窝引流管放置时间3～6 d,平均4 d。未发生胰腺损伤、胰漏、出血、脾窝感染等并发症。术后住院3～6 d,平均4.8 d。6例随访2～57个月,中位时间5.5月,无囊肿复发。结论位于上极或下极的脾脏良性肿物可以在腹腔镜下施行部分脾切除术,手术安全且创伤小。

Objective To evaluate the safety and feasibility of laparoscopic partial splenectomy. Methods Medical records of 8 patients with splenic cyst were reviewed retrospectively. The patients were diagnosed with CT or MRI and received laparoscopic partial splenectomy in our hospital from April 2008 to November 2012. The maximum size of the tumors ranged from 5.3 to 17.2 cm in diameter （mean, 8.9 em）. During the operation, pneumoperitoneum was established with a 10 mm trocar through the inferior umbilical fold. At the hilum of spleen, the upper pole or anus perineum blood vessels were isolated to cut and partially remove the spleen to follow ischemia line. Results All of the six operations were completed by laparoscopy within 175 to 325 minutes （mean, 230.8 minutes）. During the operation, a median of 150 ml blood loss was measured （50 -700 ml）. After the procedure, spleen fossa drainage was maintained for 3 to 6 days （ mean, 4 clays）. The mean hospital stay of the patients was 4.8 days （3 - 6 days）. None of them had pancreatic injury, pancreatic fistula, hemorrhage, or spleen fossa infection. The 6 patients were followed up for 2 to 57 months （ median, 5.5 months） ,and none of them showed recurrence during the period. Conclusion Laparoscopic partial splenectomy is safe and less traumatic for benign splenic tumors.