脾动、静脉主干预先阻断技术在创伤性脾破裂腹腔镜全脾切除术中的应用

Application of pre-occlusion of splenic artery and vein in laparoscopic total splenectomy for traumatic splenic rupture

目的总结脾动、静脉主干预先阻断技术应用于创伤性脾破裂腹腔镜全脾切除术中的手术要点和临床体会。方法回顾性分析2016年12月—2019年12月武汉科技大学附属天佑医院普外科行腹腔镜全脾切除术治疗的50例创伤性脾破裂患者临床资料,其中男性32例,女性18例;年龄18~56岁,平均36.7岁。道路交通伤32例,挤压伤8例,击打伤10例;均为闭合性损伤。对手术方法、术中情况(手术时间、术中出血量)、术后恢复情况(胃肠功能恢复时间、平均住院日、并发症)进行分析和讨论。结果50例患者均顺利行腹腔镜下全脾切除术,无一例患者中转开腹手术,无一例术中死亡。手术时间为(95.9±15.1)min;术中出血量为(138.9±54.0)mL。术后恢复均较好,胃肠道功能恢复于(1.9±0.4)d;腹腔引流液引流量(133.2±15.0)mL,术后(1.9±0.5)d拔出引流管;术后(1.7±0.5)d开始下床活动;术后住院时间(6.9±0.5)d。1例因切口脂肪液化引起切口感染经换药及对症治疗后痊愈,2例术后发热(脾热)患者经对症治疗后痊愈。1例胰漏患者行非手术治疗病情稳定后带管出院,1个月后复查无异常后拔管痊愈。3例胸腔积液患者经非手术治疗痊愈。无腹腔感染、肺部感染、胃瘫等手术并发症。结论腹腔镜全脾切除术治疗创伤性脾破裂中运用脾动、静脉主干预先阻断方法,能够迅速有效地控制脾出血,使术中视野更清楚,减少术中出血量、节省手术时间、避免副损伤、减少术后并发症、加速术后恢复,是一种安全、有效的手术方式。

Objective To summarize the main points and clinical experience of pre-occlusion of splenic artery and vein applied in laparoscopic total splenectomy for traumatic splenic rupture.Methods From Dec.2016 to Dec.2019,50 patients with traumatic splenic rupture underwent laparoscopic total splenectomy by pre-occlusion of the main splenic artery and vein in Tianyou Hospital Affiliated to Wuhan University of Science and Technology.There were 32 males and 18 females,with an average age of 36.7 years(range,18 to 56 years).There were 32 cases of road traffic injury,8 cases of crush injury and 10 cases of striking injury.All were closed injury.The operation methods,intraoperative conditions(operation time,intraoperative blood loss),postoperative recovery(gastrointestinal function recovery time,average length of stay,complications)were analyzed and discussed.Results Laparoscopic total splenectomy with pre-occlusion of the main artery and vein of the spleen was successfully performed in all 50 patients,no patient was converted to open surgery,and no patient died during the operation.The operation time was(95.9±15.1)minutes;the intraoperative blood loss was(138.9±54.0)mL;the postoperative recovery was good,and the gastrointestinal function recovered within(1.9±0.4)days.The volume of drainage fluid in the abdominal cavity was(133.2±15.0)mL.The abdominal drainage tube was usually removed(1.9±0.5)days after surgery.At(1.7±0.5)days after operation,the patients began to get out of bed.The postoperative length of hospital stay was(6.9±0.5)days.One case of incision infection caused by incision fat liquefaction recovered after dressing change and symptomatic treatment,and two cases of postoperative fever(splenic fever)recovered after symptomatic treatment.One patient with pancreatic leakage received conservative treatment and was discharged with tube after stable condition,and recovered after extubation after re-examination one month later.Three patients with pleural effusion recovered after conservative treatment.There was no abdominal infection,pulmonary infection,gastroparesis or other complications.Conclusion The laparoscopic total splenectomy in the treatment of traumatic splenic rupture through pre-occlusion of the main splenic artery and vein,can quickly and effectively control splenic bleeding,make the intraoperative vision clearer,reduce intraoperative blood loss,save operation time,avoid side injury,reduce postoperative complications,and accelerate postoperative recovery,which is a safe and effective surgical method.