两钉法断离脾蒂在腹腔镜下脾切除术中应用

Application of splenic hilar cut by two-nail method in laparoscopic splenectomy

目的探讨两钉法断离脾蒂行腹腔镜下全脾切除术(laparoscopic total splenectomy,LS)安全性、有效性。方法回顾性分析2016年02月~2020年05月我院肝胆胰脾外科收治40例腹腔镜脾切除术的临床资料和手术过程,其中16例采用两钉法断离脾蒂的腹腔镜脾切除术,24例采用常规技术处理脾蒂的腹腔镜脾切除术。结果16例采用两钉法腹腔镜脾切除术,两钉法组与常规组在中转开腹情况0/16,7/24(P<0.05),严重并发症发生0/16,5/24(P<0.05);以及手术时间185.63±59.21min,320.83±98.33min(P<0.05),胰尾脾脏分离度越大更易适合两钉法手术。24例行常规断离脾蒂腹腔镜脾切除术,中转7例,其中手术相关并发症发生5例,1例胰漏引流后痊愈,1例腹腔出血后进腹止血,消化道出血2例,胰腺炎1例;对于单纯腹腔镜脾切除,脾蒂处理方式是中转重要因素,同时加行腹腔镜胆囊切除术增加中转率;腹腔镜脾脏切除术中转与脾静脉宽度以及脾切除疾病类型、脾脏大小、手术医生经验、体重指数、性别没有相关性。结论合理灵活运用两钉法处理脾蒂技巧是腹腔镜脾手术成功的关键,减少中转率且促进患者恢复,减少并发症发生;术中操作关键远离胰尾建立脾蒂后隧道,操作切忌粗暴,避免脾脏损伤出血被迫中转开腹。

Objective To explore the safety and effectiveness of two-nail for splenic hilar removal in laparoscopic total splenectomy(LS).Methods A retrospective analysis of the clinical data and surgical procedures of 40 cases of LS performed by the department of hepatobiliary,pancreatic and splenic surgery in our hospital from February 2016 to May 2020.including 16 cases were splenic hilar cut off by two-nail method and 24 cases of laparoscopic splenectomy using classic technique Results Sixteen cases underwent two-nail method laparoscopic splenectomy.The two-nail method group and the conventional group were converted to laparotomy O/16,7/24(P<0.05),and serious complications occurred 0/16,5/24(P<0.05);and the operation time was 185.63±59.21min,320.83±98.33min(P<0.05),The greater the separation of pancreas tail and spleen is more suitable for two-nail surgery;Twentyfour cases underwent The classic technique(CT)with splenic hilar removed,and 7 cases were transferred.Among them,5 cases had operation-related complications.One case was cured after pancreatic leakage,one case was hemorrhage after abdominal bleeding,gastrointestinal bleeding was 2 cases,and pancreatitis 1 case.For simple LS,the treatment of the splenic hilar is an important factor in the conversion(P<0.05),and the addition of laparoscopic cholecystectomy increases the conversion of LS(P<0.05),There was no correlation between the width of the splenic vein,disease type,Spleen related diseases,spleen size,surgeon's experience,body mass index,and gender.Conclusion Flexible use of two-nail method splenic hilar handling skills is the key to the success of LS surgery,reduce transfer rate and promotes the recovery of patients and reduces complications.During the operation,the key is to stay away from the tail of the pancreas to establish a posterior splenic hilar tunnel.The operation should not be rough and avoid bleeding from spleen injury,Forced to switch to the conversion.