腹腔镜脾切除术的临床应用(附85例报告)

The clinical application of laparoscopic splenectomy:with a report of 85 cases

目的：总结腹腔镜脾切除术（laparoscopic splenectomy,LS）的手术经验及适应证。方法：回顾分析2012年1月至2014年8月为85例患者行LS的临床资料,其中男38例,女47例,7~76岁。原发性血小板减少性紫癜44例,自身免疫性溶血性贫血4例,朗格罕氏细胞肉瘤1例,噬血细胞组织增生症1例,淋巴瘤1例,血管瘤5例,血管淋巴管瘤1例,窦岸细胞血管瘤1例,错构瘤1例,脾囊肿2例,脾梗死1例,外伤性脾破裂15例,肝硬化门脉高压脾功能亢进8例。结果：85例均顺利完成LS,其中62例行单纯脾切除术,手术时间平均（95±18）min,术中失血量平均（80±20）ml;15例外伤性脾破裂者,腹腔平均积血（615±280）ml,术中失血量平均（150±36）ml,手术时间平均（105±25）min;8例肝硬化门脉高压脾功能亢进患者同时行贲门周围血管离断术,术中失血量平均（350±150）ml,手术时间平均（210±35）min。术后24 h开始进食,平均住院（6.5±2.8）d。1例术后出现A级胰瘘,经引流痊愈;3例术后出现腹水（均为肝硬化患者）,经利尿、保肝等治愈。结论：对于选择性病例,LS具有安全、微创的优势,术中仔细解剖并妥善处理脾周血管及脾蒂是LS成功的关键。

Objective：To summarize the surgical experiences and indication of laparoscopic splenectomy. Methods：Laparoscopic splenectomy was performed in 85 consecutive patients from Jan. 2012 to Aug. 2014. There were 38 males and 47 females with the age of 7 to 76 years old. Their clinical data were retrospectively analyzed. The diagnoses included idiopathic thrombocytopenic purpura（n = 44）,autoimmunity hemolytic anemia（n = 4）,Langerhans cell sarcoma（n = 1）,hemophagocytic syndrome（n = 1）,lymphoma（n= 1）,angioneoplasm（ n = 5）,hematolymphangioma（ n = 1）,littoral cell angioma（ n = 1）,hamartoma（ n = 1）,splenic cyst（ n = 2）and infarction of spleen（ n = 1）,traumatic spleen rupture（ n = 15） and portal hypertension due to cirrhosis（ n = 8）. Results：All of the85 cases were completed the laparoscopic splenectomy successfully. For the 62 cases of simple splenectomy,the mean operative time was（95 ± 18） min and the mean intraoperative blood loss was（80 ± 20） ml. For the 15 cases with traumatic splenic rupture,the average peritoneal cavity hematocele was（615 ± 280） ml,the mean intraoperative blood loss was（150 ± 36） ml and the mean operation time was（105 ± 25） min. For 8 cases of portal hypertension due to cirrhosis,laparoscopic splenectomy combined with pericardial devascularization was performed,the mean intraoperative blood loss was（350 ± 150） ml and the mean operation time was（210 ± 35） min. All of the patients recovered smoothly,feed was given 24 h after the operation and the mean hospital stay was（6. 5 ± 2. 8） d. Postoperative complications included 1 case of pancreatic fistula（ Grade A） and 3 cases of ascites due to hepatic cirrhosis. All these patients recovered quickly after drainage or diuresis and hepatoprotection. Conclusions：Laparoscopic splenectomy is safe and minimally invasive,and can be performed for selected patients. Careful and fine dissection of splenic blood vessel and pedicel is the key approach of laparoscopic splenectomy.