腹腔镜下脾脏切除术50例

Laparoscopic Splenectomy: a Report of 50 Cases

目的探讨腹腔镜脾脏切除术(laparoscopic splenectomy,LS)治疗继发性脾功能亢进的安全性、有效性。方法2001年7月~2012年6月行LS治疗50例继发性脾功能亢进。经脐孔穿刺建立气腹,腔内直线型切割吻合器(Endo-GIA)离断脾蒂。结果顺利完成50例LS,无一例中转开腹手术。6例发现副脾,术中切除。平均手术时间150 min(70~270min),平均出血量100 ml(50~200 ml)。术后48 h后血小板平均上升250×109/L(200×109/L^350×109/L)。术后住院3~7 d,平均5 d。1例术后12 h因脾窝积血再次腹腔镜探查,清除积血。1例术后出现急性胰腺炎,经治疗痊愈。50例术后随访24~60个月,平均36个月,脾功能亢进无复发。结论 LS治疗继发性脾功能亢进安全、有效。

Objective To evaluate the safety and efficacy of laparoscopic splenectomy （ LS） for secondary hyperplenism . Methods From July 2001 to June 2012, 50 patients were diagnosed as having secondary hypersplenism and received LS in our hospital.During the operation , pneumoperitoneum was established with a 10 mm trocar through the inferior umblical fold , and then the splenic pedicle was cut off by using an Endo-GIA. Results All the 50 operations of LS were completed within 70-270 min （mean, 150 min） , without conversions to open surgery .An accessory spleen was found in 6 cases and was removed during the operation .The intraoperative blood loss was 50-200 ml （mean, 100 ml）.The mean platelet levels increased by 250 ×109/L （200 ×109/L-350 × 109/L） in 48 hours after surgery.The mean hospital stay was 5 days （range, 3 -7 days）.One patient received a reoperation of laparoscopic exploration to clear spleen fossa hematocele in 12 hours after surgery .Acute pancreatitis occurred in 1 case, which was cured after medical treatment.All the patients were followed up for 24 -60 months（mean,36 months）,and none of them had hypersplenism recurrence . Conclusion Laparoscopic splenectomy is safe and effective for secondary hypersplenism .