完全性腹腔镜脾切除术82例临床分析

Clinical analysis of 82 cases undergone total laparoscopic splenectomy

目的探讨完全性腹腔镜脾切除术(laparoscopic splenectomy,LS)的可行性。方法 2009年6月至2012年8月我院共行LS 82例,超声刀游离脾周韧带,腔镜直线型切割吻合器离断脾蒂,脾脏装入塑料袋剪碎取出。结果 LS成功73例,手术时间90~300 min[(162.5±56.3)min],术中出血量50~1000 ml[(356.7±266.4)ml],术后住院3~14 d[(6.7±3.0)d]。9例中转开腹,2例为脾蒂出血;4例为胃短血管出血;2例为脾周围粘连紧密出血;1例肝炎后肝硬化门脉高压巨脾患者,凝血功能异常,术中出血多,中转开腹后并发弥漫性血管内凝血,术后2天死亡。24例肝炎后肝硬化合并脾功能亢进者,术后22例血小板恢复正常,2例血小板不升,其中1例死亡。35例溶血性贫血术后血红蛋白升高。14例特发性血小板减少性紫癜中血小板恢复正常,2例术后无升高。结论只要严格掌握手术适应证,LS仍是肝胆外科一个安全有效的手术方式。

Objective To investigate the feasibility of laparoscopic splenectomy （LS）. Methods Laparoscopic spl^nectomy was performed in 82 cases from June 2009 to August 2012 in our hospital. The splenic ligaments were disconnected using a harmonic scalpel and the pedicle of spleen was cut using the ETHELON 60. After the spleen was mobilized,it was placed into an extraction bag, broken into small pieces, and removed from the extraction incision. Results The operation was successfully completed in 73 cases inwhich the operation time was 90 -300 mini （162. 5 ± 56. 3 ）mini, the bleeding amount was 50 - 1000 ml [ （356. 7 ±266.4 ）ml ], and the length of postoperative hospital stay was 3 - 14 d[ （6. 7±3. 0） d]. There were nine eases converted to laparotomy. Of the nine eases, two eases were due to hemorrhage of the splenic pedicle ,four eases were due to hemorrhage of the short gastric vessels, two eases were due to extensive adhesion, and one case was due to portal hypertension post hepatitie cirrhosis, massive splenomegaly and coagulation disorders, and died after 2 days with DIC. After operation, in 24 eases with post-hepatitie cirrhosis and laypersplenism, the platelet count was recovered to normal levels in 22 eases and unchanged in two eases,in which one was died. In 35 eases with hemolytic anemia,the hemoglobin levels were elevated;and in 16 eases with idiopathic thromboeytopenic purpura（ITP） , the platelet count was recovered to normal levels in 14 cases and unchanged in two cases. Conclusion Laparoseopic splenectomy is a safe and feasible surgery with strict operation indication.