腹腔镜下二级脾蒂离断法原位脾切除术治疗外伤性脾破裂的应用体会

Application of spleen subpedicle severance for laparoscopic splenectomy in traumatic splenic rupture patients

目的探讨腹腔镜二级脾蒂离断法原位全脾或部分脾切除术对外伤性脾破裂(TSR)患者的疗效。方法收集杭州市第一人民医院肝胆胰外科2012年6月至2015年8月间收治的17例TSR患者,结合术前CT检查和术中腹腔镜探查,并根据2000年第六届全国脾脏外科学术研讨会制订的脾损伤分级标准确定脾损伤等级,再行全脾切除或部分脾切除,并观察术中及术后恢复情况。结果 17例患者中Ⅰ级脾损伤3例,Ⅱ级5例,Ⅲ级7例,Ⅳ级2例。平均手术时间为(78±12)min,平均回输自体血(750±23)ml,平均出血量(220±45)ml。所有病例均在术后3 d内肛门恢复排气并恢复饮食,平均住院(11.7±2.1)d,且术后随访无相关远期并发症发生。结论腹腔镜二级脾蒂离断法原位全脾或部分脾切除术治疗TSR患者安全有效。

Objective To evaluate the value of the technique of spleen subpedicle severance for laparoscopic splenectomy in traumatic splenic rupture（TSR） patients. Methods Totally 17 TSR patients in the Department of Hepatobiliary and Pancreatic Surgery in Hangzhou First People＇s Hospital were collected. Based on CT diagnosis before operation and laparoscopic exploration during operation, the levels of spleen injury of TSR patients were determined, following by the standard classification of spleen injury which was released in the sixth national conference on spleen surgery in 2000. The total splenectomy or partial splenectomy were operated during surgery based on the levels of spleen injury, the intraoperative observation and postoperative recovery were recorded. Results There were 3 cases of levelⅠspleen injury, 5 cases of levelⅡ, 7 cases of level Ⅲ, and 2 cases of level Ⅳ in total 17 TSR cases. The mean operation time was（78 ± 12） min, the mean volume of autologous blood transfusion during operation was（750 ± 23） ml, and the mean volume of bleeding was（220 ± 45） ml. All TSR patients recovered anus exhaust and diet in 3 d after surgery, the mean hospital stay was（11.7 ± 2.1） d, and no associated long-term complication was found in post-operation follow-up. Conclusion The technique of spleen subpedicle severance for laparoscopic splenectomy in TSR patients is safe and effective.