目的 探讨经脐隐蔽切口腹腔镜脾切除术的可行性、安全性、手术技巧及临床效果.方法 回顾性分析2011年11月至2014年11月山东大学齐鲁医院开展的经脐隐蔽切口腹腔镜脾切除(A组,n=9)及同期传统腹腔镜脾切除(B组,n=15)手术资料,对比两组手术时间、术中出血量、术后并发症、住院时间、切口满意程度、总住院费用等指标.纳入疾病包括免疫性血小板减少症、遗传性球形红细胞增多症及单纯性脾亢.结果 24例腹腔镜手术均取得成功.两组术中出血量及住院花费差异无统计学意义[分别为(196.7±118.7) ml、(188.7±110.8)ml;(3.7±0.5)万元、(3.6±0.7)万元,P＞0.05].经脐腹腔镜脾切除美观满意度评分明显优于LS[分别为(4.1±0.6)、(3.4±0.7),P＜0.05];而手术时间明显长于传统腹腔镜脾切除[分别为(201.7±43.2) min、(131.0±37.1)min; P＜0.05].术后随访3～28个月两组均无严重临床并发症发生.结论 经脐隐蔽切口腹腔镜脾切除术较传统腹腔镜脾切除虽然操作时间较长,但安全可行,可以取得更好的美容效果.%Objective To study the feasibility,safety,operative skills and clinical advantage of natural orifice transumbilical laparoscopic splenectomy.Methods The clinical data of patients who underwent natural orifice transumbilical laparoscopic splenectomy (group A,n =9) and conventional laparoscopic splenectomy (group B,n =15) in our department from Nov.2011 to Nov.2014 were reviewed.The operative time,estimated blood loss,post-operation complications,hospital stay,incision satisfaction score and total cost were compared between two groups.Patients with immune thrombocytopenia,presume hereditary splecocytosis and idiopathic hypersplenism were included.Results All the procedures were successfully carried out laparoscopically.The estimated blood loss and total cost showed no significant differences between group A and group B [(196.7 ± 118.7) ml vs (188.7 ± 110.8) ml ; (3.7 ± 0.5) vs (3.6 ± 0.7) × 104 yuan,P ＞ 0.05].As to the incision satisfaction score,group A was superior to group B [(4.1 ± 0.6) vs (3.4 ± 0.7),P ＜ 0.05].The operation time of group A was significantly longer than that of group B [(201.7 ± 43.2) min vs (131.0 ± 37.1) min,P ＜ 0.05].Conclusion Natural orifice transumbilical laparoscopic splenectomy is a safe and feasible procedure with better satisfactory clinical outcomes than conventional laparoscopic splenectomy.
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