改良完全腹腔镜下巨脾切除加贲门周围血管离断术的手术配合

The operative cooperation of the modified complete laparoscopic splenectomy plus esophagogastric devascularization

目的：探讨改良完全腹腔镜下脾切除加贲门周围血管离断术的手术配合。方法：回顾性分析我院2010年1月～2013年3月施行改良完全腹腔镜下脾切除加贲门周围血管离断术41例患者的临床资料。结果：早期2例因术中难控制性出血行中转开腹,余39例患者均在完全腹腔镜下施行,平均手术时间（221±60）min,平均失血量（190±167）ml,术后（10.4±2.2）d出院,术后仅1例患者出现并发症,随访3个月至1年均无再次出血发生。结论：改良完全腹腔镜下脾切除加贲门周围血管离断术,无需扩大腹壁切口,具有创伤小、并发症少、恢复快的特点。精湛的手术操作技术与娴熟的手术配合是该类手术成功的关键。

Objective： To explore the operative cooperation of the modified complete laparoscopic splenectomy plus esophagogastric devascularization. Methods：Made retrospective analysis of the clinic documents of 41 cases of patients who had undergone the modified complete laparoscopic splenectomy plus esophagogastric devascularization from January 2010 to March 2013. Results： Only two cases,on the early stage,converted to the laparotomy because of the uncontrollable intraoperative bleeding. The rest 39 cases of patients all undergone the complete laparoscopic operation with the average operative duration of（ 221 ± 60）minutes,average blood lose volume of（ 190 ± 167） ml and discharge from hospital after（ 10. 4 ± 2. 2） postoperative days. Only 1 case of patient had suffered complications,and all patients had no second hemorrhage occurrence in the follow- ups during 3 to 12 months after their operations. Conclusion： The modified complete laparoscopic splenectomy plus esophagogastric devascularization neen＇t require enlarging the abdominal wall incision and has the advantages of few complications and rapid recovery. The key to the success of this kind of operation is the exquisite operative techniques and adept operative cooperation.