腹腔镜巨脾切除术29例临床分析

目的 探讨腹腔镜巨脾切除术的安全性及临床疗效.方法 对29例巨脾伴脾功能亢进行腹腔镜脾切除术患者的临床资料进行回顾性分析.结果 28例成功行腹腔镜脾切除术,1例中转开腹.手术时间为100～210min,平均(160±30)min;术中出血量为50～1200ml,平均(150±50)ml;术后住院4～9d,平均(6±2)d.术后并发脾热2例.结论 随着腹腔镜器械的改进和操作技巧的熟练,腹腔镜巨脾切除术是安全可行且疗效确切的.     

LigaSure血管闭合系统在腹腔镜脾功能亢进脾切除术中的应用(附28例报告)

目的:探讨LigaSure闭合系统在脾功能亢进患者行腹腔镜脾切除术中的应用价值。方法:为28例脾功能亢进患者施行完全腹腔镜脾切除术。应用LigaSure离断脾周韧带及部分脾蒂血管。结果:28例手术均获成功。手术时间55～210min,平均120min。术中出血30～220ml,平均115ml(不包括脾血)。22例术后少量腹水。术后12～24h恢复胃肠蠕动,术后24h拔除胃管并进流质饮食,术后住院5～9d,平均6.5d。结论:LigaSure可安全、有效地闭合脾周韧带和大部分血管,减少了术中出血,降低了手术风险。     

腹腔镜脾切除术在基层医院应用的初步体会

目的:探讨腹腔镜脾切除术在基层医院的可行性及注意事项。方法:回顾分析2012年9月至2015年5月16例腹腔镜脾切除术患者的临床资料。结果:16例患者中13例顺利完成腹腔镜脾切除术,其中2例联合施行腹腔镜胆囊切除术;3例因出血中转开腹,无死亡病例。手术时间145~390 min,平均(250.4±70.5)min;术中出血量30~500 ml,平均(204.6±151.5)ml,1例输血;术后1~6 d开始进食,平均(2.4±1.6)d;术后住院4~12 d,平均(7.4±2.5)d。术后并发高热2例、门静脉血栓1例,均予以对症处理后好转。结论:在选择合适病例及熟练掌握腹腔镜操作技术的前提下,腹腔镜脾切除术在基层医院开展是安全、可行的,开展初期宜选择特发性血小板减少性紫癜或脾良性肿瘤等脾脏较小的病例。     

腹腔镜脾切除术治疗外伤性脾破裂的体会

目的:探讨腹腔镜脾切除术治疗外伤性脾破裂的技术要点。方法:用完全腹腔镜脾切除术治疗6例外伤性脾破裂患者,其中Ⅱ级损伤3例,Ⅲ级损伤3例,3例合并其他脏器损伤。结果:6例均顺利完成手术,无中转开腹。手术时间80～150min,平均110min。术中出血200～500ml,平均350ml。术后3例单纯性脾破裂者平均住院7d,3例伴合并伤者平均住院15.6d,术后患者顺利康复,无并发症发生。结论:腹腔镜脾切除术治疗外伤性脾破裂安全、可行,但有一定的技术难度。     

手助腹腔镜脾切除联合贲门周围血管离断术治疗门脉高压症

目的:探讨手助腹腔镜脾切除联合贲门周围血管离断术治疗门脉高压症的手术方法及技巧。方法:2009年7月至2011年12月为26例肝硬化门脉高压患者行手助腹腔镜脾切除联合贲门周围血管离断术。结果:26例均顺利完成手助腹腔镜手术,手术时间167～237 min,平均187 min;术中出血量467～1 820 ml,平均510 ml;术后住院7～16 d,平均9.7 d;术后无死亡病例及严重并发症发生。结论:手助腹腔镜脾切除术联合贲门周围血管离断术治疗门脉高压症安全、微创、可行,明显降低了复杂腹腔镜手术的难度及风险,手术成功的关键是防止术中大出血。     

腹腔镜原位二级脾蒂离断法在外伤性脾破裂脾切除中的应用

目的探讨原位二级脾蒂离断法在外伤性脾破裂腹腔镜脾切除术中的应用价值。方法 2013年1月~2014年1月对16例创伤性脾破裂腹腔镜下采用钛夹离断二级脾蒂切除脾脏。结果 15例成功行腹腔镜下二级脾蒂离断脾切除术,1例应用直线切割闭合器(Endo-GIA)切除。15例术中自体血回输400~2000 ml,平均1100 ml。术后均无继发感染、再出血、胰漏等并发症。手术时间55~105 min,平均75 min。术后24 h拔除盆腔引流管,72 h内拔除脾窝引流管。5例合并四肢及骨盆骨折术后1周内接受相应的骨折内固定手术。术后8~16 d出院,平均11.5 d。16例术后随访6个月,无门静脉血栓、肠梗阻等严重并发症。结论腹腔镜下原位二级脾蒂离断法脾切除术治疗外伤性脾破裂安全可行,便于合并症的术后处理。     

腹腔镜巨脾切除术

目的:探讨腹腔镜巨脾切除术的手术方法、安全性及有效性。方法:回顾分析1996年4月至2009年3月我院为72例巨脾患者行腹腔镜脾切除术的临床资料,其中38例同时行门奇静脉断流术。结果:本组70例手术均获成功,手术时间1.8～5.5h,出血60～400ml,2例中转开腹(2.7%)。2例术后腹腔出血,其中1例再次行腹腔镜探查创面止血,1例做小切口开腹止血;3例发生膈肌破裂,1例结肠脾曲破裂,4例术后发热(>38℃),1例切口血肿。术后1～5d肛门恢复排气,术后住院7～15d,平均10.5d。结论:腹腔镜巨脾切除术安全、有效,适用于脾功能亢进和巨脾患者。     

腹腔镜脾切除术的经验总结

目的:探讨腹腔镜脾脏切除术的手术技巧和临床效果。方法:回顾分析我院2001年7月至2007年1月问33例腹腔镜脾脏切除术的手术时间、术中失血量、术后并发症等。结果:33例病人中有2例因为睥脏明显肿大,直接行腹腔镜下手助脾脏切除;1例因术中脾静脉出血转手助操作完成手术:余30例行完全腹腔镜下脾脏切除术;无中转开腹术。手术平均时间为(86．54±30．43)min(50～200 min),术中平均失血量为(110±171．24)ml(25～800 ml)。术后拔除引流管的平均天数为4．73(2～21)d。术后平均住院天数为8．76(4～55)d。无死亡病例。手术后有1例并发少量胰漏,引流3周后愈合。结论:腹腔镜脾脏切除术安全可行,必要时可以手助下完成手术。     

两种腹腔镜手术治疗巨脾的疗效研究

目的:探讨手助巨脾微创切除及同步脾血回输的疗效。方法:回顾分析50例门静脉高压症伴脾亢患者的临床资料,将患者分为完全腹腔镜组(n=20)与手助腹腔镜组(n=30),术中均行同步脾血回输,对比两组患者的临床疗效。结果:手助腹腔镜组术中出血量平均(88.10±16.32)ml,无术后并发症发生;完全腹腔镜组术中出血量平均(94.20±12.32)ml,术后并发症发生率为5.00%,两组差异无统计学意义(P0.05),但手助腹腔镜组手术时间[(75.20±12.31)min]、取脾时间[(8.20±3.11)min]、术后住院时间[(8.91±1.20)d]均短于完全腹腔镜组[(120.70±19.31)min、(25.20±2.71)min、(11.02±0.93)d],差异有统计学意义(P0.05)。重度脾肿大患者术中出血量[(103.85±26.02)ml]、手术中转率(20.00%)均显著高于中度脾肿大患者[(70.41±10.28)ml、0.00%],差异有统计学意义(P0.05)。同步脾血回输后的血红蛋白水平[(119.21±8.70)g/L]显著高于输血前[(98.21±5.62)g/L],差异有统计学意义(P0.05)。结论:与完全腹腔镜巨脾切除术相比,手助巨脾微创切除术治疗门静脉高压症伴脾亢操作更快捷,安全性更高,同步脾血回输利于患者血红蛋白水平的恢复,具有临床推广价值。     

腹腔镜脾切除术治疗遗传性球形红细胞增多症(附18例报道)

目的探讨腹腔镜脾切除术治疗遗传性球形红细胞增多症的可行性、手术技巧及效果评价。方法收集我科2006年1月至2008年1月收治的行腹腔镜脾切除术治疗的遗传性球形红细胞增多症患者18例的临床资料进行回顾性分析。结果所有患者均顺利完成腹腔镜脾切除术。术中出血50～600ml,平均200ml。手术时间50～150min,平均136min（包括胆囊切除时间）。术后住院时间5～10d,平均7.8d,所有患者住院期间无暴发感染、胰漏等并发症发生。术后随访4～12个月,平均6.7个月,术前症状完全消失。结论腹腔镜脾切除术是治疗遗传性球形红细胞增多症的一种安全有效的方法。     

儿童腹腔镜脾切除的初步体会

目的:总结儿童腹腔镜脾切除的经验和特点。方法:回顾性分析21例小儿腹腔镜脾切除患者的临床资料。结果:顺利完成腹腔镜脾切除术18例,中转开腹3例。1例因巨大脾装入取物袋困难,采用下腹横切口取出,余均经腹壁戳孔在取物袋中夹碎后取出。术中除1例出血达300ml外,余均少于10ml。发现副脾2例。术中损伤胃壁1例,术后出血1例。所有患儿术后恢复好,平均2d进食,住院5～11d。随访1个月～3年,患者生长发育良好,无严重感染,贫血和血小板计数明显改善。结论:小儿腹腔镜脾切除术具有创伤小、康复快、住院时间短且腹壁美容的优点,是一种安全、有效的术式。     

Portal vein thrombosis after laparoscopic splenectomy for systemic mastocytosis: a case report and review of the literature

INTRODUCTION: Laparoscopic splenectomy has become the surgical procedure of choice for various diseases of the spleen. Portal vein thrombosis (PVT) after splenectomy occurs in 0.5% to 22% of patients. Symptoms are nonspecific and include fever, abdominal pain, and epigastric distress. Risk factors for PVT after splenectomy include underlying hematologic disorders, massive splenectomy, and other hypercoagulable states. METHODS: We describe a case of PVT in a woman who underwent laparoscopic splenectomy for symptomatic splenomegaly secondary to systemic mastocytosis. The patient was discharged from the hospital without anticoagulation and experienced nonspecific symptoms beginning 10 days postoperatively. Diagnosis of PVT was made by contrast-enhanced abdominal computed tomography. The patient had no underlying risk factors. Anticoagulation treatment facilitated recanalization of the portal vein and this was verified by Doppler ultrasound at follow-up. CONCLUSIONS: PVT after laparoscopic splenectomy is not uncommon. Signs and symptoms are vague and require a high index of suspicion for timely diagnosis. Anticoagulation is the treatment of choice and allows recanalization of the portal system in the majority of cases.     

Hand-assisted laparoscopic splenectomy for a huge splenic cyst: operative technique and case report

We report the case of a huge splenic cyst that was successfully treated by hand-assisted laparoscopic splenectomy. A 17-year-old girl with a chief complaint of left-sided abdominal pain was admitted to our department for investigation of a splenic tumor. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a huge cystic lesion in the spleen measuring approximately 10 cm in diameter. Hand-assisted laparoscopic splenectomy was safely performed to diagnose and treat the splenic tumor. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall. Hand-assisted laparoscopic splenectomy may be a good method of managing a huge splenic cyst that becomes symptomatic and potentially life-threatening through enlargement, rupture, and secondary infection.     

Results of laparoscopic and open splenectomy for nontraumatic diseases

The medical records of patients who had undergone splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic splenectomy for nontraumatic splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.5%) who underwent laparoscopic splenectomy and 24 patients (54.5%) who underwent open splenectomy. Various parameters were reported for open and laparoscopic procedures separately, including associated surgical procedures, spleen weight, postoperative mortality and morbidity rates, perioperative blood transfusions, use and length of abdominal drainage, accessory spleen removal, operative times, length of hospital recovery, and hematologic parameters on admission to and discharge from the hospital. Laparoscopic splenectomy was successfully completed in all 20 considered patients with no conversion to open splenectomy. The supine position and four trocars were adopted in all patients. Accessory spleens were found in four (9.0%) patients: two (4.5%) during open splenectomy and two (4.5%) during laparoscopic splenectomy. The postoperative mortality rate was 2.7% (a case of myocardial infarction). The morbidity rate was 9% (four patients), but no postoperative complications occurred after laparoscopic splenectomy. A significant statistical difference was shown by the increase in platelet counts after open versus laparoscopic splenectomy. The open and laparoscopic mean operative times (73.70 +/- 13.42 minutes and 78.42 +/- 14.63 minutes, respectively) were comparable. These times were comparable also considering patients who underwent only splenectomy. Mean recovery time was shorter after laparoscopic splenectomy (3.95 +/- 0.60 days) than after open splenectomy (7.0 +/- 1.68 days). After open procedures, however, the mean recovery time was shorter in uncomplicated cases (6.68 +/- 1.49 days) than in the open group as a whole. Authors conclude that many well-known advantages of the laparoscopic approach. especially those related to its low invasiveness, can be observed in patients requesting splenectomy for nontraumatic diseases of the spleen, without lowering the efficacy of this operation. They suggest that such advantages can be entirely displayed when selection criteria of the patients are applied.     

Single-incision laparoscopic splenectomy for idiopathic thrombocytopenic purpura: Report of a case

We herein report a case of single-incision laparoscopic access (SILA) splenectomy for idiopathic thrombocytopenic purpura (ITP). A 24-year-old female patient with a diagnosis of ITP received corticosteroid therapy. However, as the side effects became serious, a splenectomy option was chosen. The SILA splenectomy using a transumbilical approach is cosmetically more attractive than a conventional laparoscopic approach, but it has an increased risk of major bleeding due to technical considerations. Therefore, we prioritized the patient’s safety during the SILA splenectomy by choosing a left lower abdominal approach. The operating time was 123 min and blood loss was 1 ml. This was comparable to a conventional laparoscopic splenectomy. The present case appears to be the first SILA splenectomy reported in Japan. In our experience, a SILA splenectomy is feasible and safe, with favorable perioperative and shortterm patient outcomes. Further studies are necessary before the universal adoption of this new technique.     

Laparoscopic cholecystectomy in a patient with situs inversus totalis and previous abdominal surgery

Background: Wandering spleen is a spleen lacking its normal ligamentous attachments, and thus subjected to free movement in the abdominal cavity, and even torsion around its pedicle. Surgical treatment includes either fixation (splenopexy) or resection (splenectomy). Both procedures can now be accomplished using the laparoscopic approach. Methods and results: We describe a case of a torsion of a wandering spleen, leading to recurrent episodes of abdominal pain, and eventually to splenic ischemia, necessitating splenectomy. The diagnosis was complicated by associated angiographic findings of celiac axis occlusion, possibly by median arcuate ligament compression. Laparoscopic splenectomy was successful, and led to complete resolution of symptoms. Conclusions: Although a rare condition, wandering spleen can be diagnosed accurately by imaging studies, mainly CT scan and angiography. Nowadays, the laparoscopic approach is preferred and enables the surgeon to perform either splenopexy or splenctomy, depending on the vascular status of the spleen.     

Laparoscopic splenectomy reduces the need for platelet transfusion in patients with idiopathic thrombocytopenic purpura.

OBJECTIVES: Laparoscopic splenectomy has been increasingly used in patients with idiopathic thrombocytopenic purpura. Because it is associated with minimal abdominal trauma, platelet consumption could be reduced with the laparoscopic approach. The aim of this study was to analyze intraoperative bleeding and the need for apheresis platelets, comparing laparoscopic with open splenectomy. METHODS: Records of 40 patients who underwent splenectomy (20 through laparoscopy and 20 through open surgery) for idiopathic thrombocytopenic purpura were retrospectively reviewed. Intraoperative bleeding and need of perioperative apheresis platelets were evaluated in both groups. Statistical evaluation was conducted using the Mann-Whitney rank test, and differences were considered significant at P<0.01. RESULTS: The mean amount of intraoperative bleeding was less in the laparoscopic group (P<0.01). Apheresis platelets were necessary in all patients in the open group (2 units transfused in 55% and 1 unit in 45% of cases) and only in 30% of cases in the laparoscopic group (1 unit transfused in each case). CONCLUSIONS: Laparoscopic splenectomy is a safe procedure also in patients at high risk for bleeding diathesis. In idiopathic thrombocytopenic purpura, laparoscopic splenectomy should be the gold-standard surgical treatment. Need of platelet transfusion is probably reduced when laparoscopic splenectomy is compared with open surgery in these patients.     

腹腔镜胆囊切除联合手术117例临床报告

目的探讨腹腔镜联合手术的可行性及安全性。方法回顾分析1992年3月至2006年12月间117例腹腔镜联合手术的临床资料;男性39例,女性78例,年龄为25~74岁,其中行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC) 腹腔镜阑尾切除术(laparascopic appendectomy,LA)46例;LC 肝囊肿去顶减压术15例;LC 肾囊肿去顶减压术6例;LC 肝、肾囊肿去顶减压术3例;LC 腹腔镜脾切除、门奇静脉联合断流术7例;LC 腹腔镜胃肠间质瘤切除术6例;LC 腹股沟疝修补术3例;LC 结直肠癌根治术8例;LC 粘连松解术6例;LC 子宫肌瘤剔除术6例;LC 卵巢囊肿剥除术10例;LC 肾脏错构瘤切除术1例。结果手术均顺利完成,中转开腹1例,胆漏1例,无感染、出血和胆道损伤等并发症;术后住院日平均为5.7 d。结论只要严格掌握各自疾病的手术治疗原则及联合手术的适应证,对两种或两种以上腹部病变的腹腔镜联合处理是安全有效的,具有创伤小、痛苦少、恢复快、灵活方便和多病联治的优点。     

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??Clinical research of the “modified four-step” technique applied in laparoscopic splenectomy and pericardial devascularization HONG De-fei??CHENG Jian??ZHANG Yu-hua??et al. Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital??Hangzhou 310014??China
Corresponding author: HONG De-fei, E-mail: hongdefi@163.com
Abstract Objective To summarize effect and experience of the "modified four-step" technique applied in laparoscopic splenectomy and pericardial devascularization (LSPD). Methods The clinical data of 105 cases of LSPD conducted by the " modified four-step" technique between June 2012 and June 2015 in Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital were analyzed retrospectively. Results All cases were operated successfully. Among them, 2 cases (1.9%) were converted to open surgery and the rest 103 cases were conducted successfully under complete laparoscopy. Operative time was (175.6 ± 49.8) min and blood loss was (310.9 ± 240.9) mL. Postoperative complication included 1 case of abdominal bleeding??1 case of pancreatic leakage??2 cases of abdominal infection??2 cases of splenic vein thrombosis??3 cases of hepatic dysfunction. One case of liver dysfunction with hepatic encephalopathy gave up treatment and automatically discharged. Other cases were cured by conservative treatment. Postoperative hospital stay (8.7 ± 3.6)d. Two cases ocurred recurrece of GI bleeding after following 12—48 months. Conclusion The "modified four-step" technique in LSPD has high laparoscopic success rate??low rate of postoperative complications and the low rate of GI bleeding recurrence. It’s worthy of clinical promotion and application.     

腹腔镜脾切除术21例临床分析

目的：探讨腹腔镜脾切除术的安全性及临床效果。方法：回顾性分析21例腹腔镜脾切除术患者（16例肝炎后肝硬化及3例脾梗死,1例脾包虫病,1例血吸虫性肝硬化）的临床资料。结果：21例中2例中转开腹,19例成功完成腹腔镜脾切除术,其中1例行腹腔镜下脾大部切除术。平均手术时间为150min,平均术中失血485ml,术后24～48h胃肠蠕动恢复,术后平均住院时间为12d。结论：经过选择的患者行腹腔镜脾切除术安全可行,除血液系统疾病外还适用于肝硬化患者中需行脾切除者及脾脏本身病变者。