腹腔镜手术在不同脾脏疾病中的应用

Application of Laparoscopic Surgery for Different Types of Spleen Diseases

目的:探讨腹腔镜手术治疗不同脾脏疾病的安全性及疗效。方法:回顾分析2011年行腹腔镜手术治疗的20例不同类型脾脏疾病患者的临床资料。结果:20例患者中16例顺利完成腹腔镜脾切除术(laparoscopic splenectomy,LS),3例中转改良手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS),1例中转开腹行脾切除、联合断流术。患者平均手术时间为(116.3±44.4)min(75～240 min);平均术中出血量为(108.8±235.1)mL(10～1000 mL);术后平均住院时间为(7.8±2.3)d(5～13 d)。20例患者中,术后腹腔引流液淀粉酶升高1例。术后病理结果显示,特发性血小板减少性紫癜(idiopathicthrombocytopenic purpura,ITP)5例,小B细胞性淋巴瘤1例,淤血性脾肿大8例,其余6例脾占位患者包括脾血管瘤2例、脾脉管瘤3例、继发性囊肿1例。结论:腹腔镜手术可作为脾脏疾病的首选治疗手段。

Objective：To evaluate the safety and efficiency of laparoscopic surgery for different types of spleen diseases. Methods： The clinical data of 20 patients with different types of spleen diseases who underwent laparoscopic surgery in 2011 were reviewed. Results： In 20 patients, 16 patients underwent laparoscopic spleneetomy（LS） successfully, 3 patients were converted to modified hand-assisted laparoscopic splenectomy（HALS） and 1 patient was converted to open surgery. The average operative time was （116.3 ± 44.4）min （75-240 min）; the average blood loss during operation was （108.8 ± 235.1）mL （10-1000 miD, and the average hospital stay after operation was （7.8 ± 2.3） d（5-13 d）. Amylase level in abdominal drainage fluid was high in one case. The pathologic diagnosis showed that 5 patients had idiopathic thrombocytopenic purpura（ITP）, 1 patient had small B lymphocyte lymphoma,8 patients had congestive splenomegaly,2 patients had spleen angioma,3 patients had spleen hemangioma,and 1 patient had cyst of spleen. Conclusions： Laparoscopic surgery is safe and effective in different types of spleen diseases.