经腹膜后入路单孔腹腔镜全脾切除术的临床应用效果

Application of single-port laparoscopic total splenectomy by retroperitoneal approach

目的探讨经腹膜后入路单孔腹腔镜全脾切除术的安全性和可行性。方法回顾性分析2017年1月1日至2022年12月30日云南省第一人民医院行经腹膜后入路单孔腹腔镜全脾切除术治疗的10例患者的围手术期情况及术后恢复情况。结果本组10例患者全部顺利施行经腹膜后入路单孔腹腔镜全脾切除术,无中转开腹病例,手术时间56~260 min,术中出血量20~400 mL,无术中并发症发生。术后第1天引流液淀粉酶值53~5400 U/L(中位数652.9 U/L);9例于术后第3天淀粉酶水平基本恢复正常;1例出现胰瘘(生化漏),经通畅引流后未出现后续并发症。2例出现血小板升高,经抗凝治疗后未出现后续并发症。术后住院时间5~17 d(中位时间9.2 d)。10例患者均门诊随访观察2~12个月,中位随访时间6个月,均无后续并发症。结论对于仅单纯行脾脏切除术的患者,经腹膜后入路单孔腹腔镜全脾切除术是安全可行的。

Objective To investigate the safety and feasibility of single-port laparoscopic total splenectomy by retroperitoneal approach.Methods The perioperative status and postoperative recovery of 10 patients who underwent retroperitoneal single-port laparoscopic total splenectomy in the First People’s Hospital of Yunnan Province from Jan.2017 to Dec.2022 were retrospectively analyzed.Results All the 10 patients underwent laparoscopic single-hole total splenectomy by retroperitoneal approach,with no cases requiring conversion to laparotomy.The operation time was 56-260 min,the intraoperative blood loss was 20-400 mL,and no intraoperative complications occurred.The amylase value of the drainage fluid on the 1st day after surgery ranged from 53 to 5400 U/L(median 652.9 U/L).The amylase level of 9 cases returned to normal on the 3rd day after surgery,and the other 1 case developed fistula(biochemical leakage),and no subsequent complication occurred after unobstructed drainage.There were 2 cases of postoperative platelet elavating,and no following complications occurred after anticoagulant therapy.The postoperative hospitalization time was 5-17 d(median 9.2 d).All the 10 patients were followed-up on an outpatient basis for 2-12 months(median 6 months),with no subsequent complication were observed.Conclusion For patients who only undergo splenectomy,retroperitoneal lapproscopic single-port total splenectomy is safe and feasible.