腹腔镜下脾切除术56例分析

摘要

Objective To evaluate the clinical value of laparoscopic splenectomy . Methods Clinical data of 56 patients who had undergone laparoscopic splenectomy between August 2012 and December 2013 were analyzed .The patients were placed at an elevated 45°to the right position.By using conventional four-trocar method, the ligaments around the spleen were separated , cut, and closed, or the splenic vascular vessels were ligated with Hem-o-lok, and then one of puncture holes was expended into a small incision to extract the specimen .By using hand-assisted laparoscopic approach , three-trocar method was utilized with introduction of left hand through a 5 cm abdominal incision . Results There was 1 case of conversion to open surgery because of hepatocellular carcinoma found in operation , which was given partial hepatectomy combined with splenectomy , with an operation time of 215 min and a blood loss of 520 ml.There were 48 cases of laparoscopic splenectomy .The operation time was 90 -160 min ( 105 ±15 min ) , the intraoperative blood loss was 40-550 ml (90 ±38 ml),the length of hospital stay was 5-15 d (mean, 5.7 d), and drainage time was 4-12 d (4.2 ±1.6 d).There were 7 cases of hand assisted laparoscopic splenectomy .The length of hospital stay was 4-8 d (mean, 4.8 d), the operation time was 80-140 min (95 ±20 min), the intraoperative blood loss was 200-600 ml (110 ±91 ml), and the drainage time after surgery was 2-6 d (3.6 ±1.3 d).There were 1 case of postoperative portal vein thrombosis and 1 case of mild pancreatic leakage , all of which were cured after symptomatic treatment .Follow-up examinations in 56 cases for 6 months found no hospital deaths and no postoperative liver failure or infection . Conclusion Laparoscopic splenectomy is suitable for a variety of spleen diseases .%目的：探讨腹腔镜下脾切除术的临床应用价值。方法2012年8月～2013年12月完成56例腹腔镜下脾切除术。右侧垫高45°体位。常规四孔法入路，分离脾周围韧带，切割闭合或Hem－o－lok加钛夹结扎脾门血管，穿刺孔扩大成小切口取出标本；手助式腹腔镜三孔法，上腹正中取一切口置入左手，余方法同前。结果1例因术中合并肝癌，镜下处理困难，中转开腹行肝部分切除联合脾切除术，手术时间215 min，出血520 ml。48例腹腔镜脾切除术（ laparoscopic splenectomy ， LS）手术时间90～160 min，（105±15） min；术中出血40～550 ml，（90±38） ml；引流管拔除时间术后4～12 d，（4．2±1．6） d；住院5～15 d，（5．7±2．1） d。7例手助腹腔镜下脾切除术（ hand assisted laparoscopic splenectomy ， HALS）手术时间80～140 min，（95±20） min；术中出血200～600 ml，（110±91） ml；引流管拔除时间术后2～6 d，（3．6±1．3） d；住院4～8 d，（4．8±1．5） d。1例术后门静脉血栓，1例术后轻度胰漏，对症处理后好转出院。56例随访6个月，无死亡，无术后肝功能衰竭、感染等。结论腹腔镜下脾切除术操作简便，在手术技术熟练的情况下能安全有效的适用于各种脾脏疾病。