腹腔镜脾切除术的临床体会(附51例报告)

The clinical experience of laparoscopic splenectomy: with a report of 51 case

目的:总结腹腔镜脾切除术(laparoscopic splenectomy,LS)的手术经验与临床体会。方法:回顾分析2005年7月至2011年7月为51例患者行LS的临床资料,其中原发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)38例,先天性溶血性贫血4例,遗传性球形红细胞增多症3例,门静脉高压症伴脾亢2例,外伤性脾破裂4例。结果:46例成功完成手术,5例中转手助腹腔镜手术。手术时间120～180 min,平均(150±12.1)min;术中出血量50～500 ml,平均(150±11.3)ml。术后住院3～7 d,平均(5±0.6)d,术后无并发症发生。38例ITP患者中37例血小板恢复正常,1例术后升高后又降低。结论:LS安全可行,术前准备工作、术中体位、术者与助手的配合及脾蒂处理是手术成功的关键。

Objective： To explore and summarize the surgical and clinical experiences of laparoscopic splenectomy（LS）.Methods： The clinical data of 51 patients who underwent LS between Jul.2005 and Jul.2011 were retrospectively analyzed.There were 38 cases of idiopathic thrombocytopenic purpura（ITP）,4 cases of congenital hemolytic anemia,3 cases of hereditary spherocytosis,2 cases of portal hypertension with hypersplenism,and 4 cases of traumatic spleen rupture.Results： Forty-six operations were successfully done,5 cases were converted to hand-assisted laparoscopic surgery.The operating time was 120-180 min,mean（150 ± 12.1） min;the intraoperative blood loss was 50-500 ml,mean（150 ± 11.3） ml;the average postoperative hospital stay was 3-7 d,mean（5 ± 0.6） d.There was no postoperative complication.Among the 38 ITP cases,the platelets in 37 cases recovered,while they increased and then decreased in 1 case after surgery.Conclusions： LS is a safe and feasible technique.The key points of the successful surgery are associated with preoperative preparation,intraoperative position,the cooperation between the surgeon and his assistants,and splenic pedicle handling.