腹腔镜脾脏切除术中出血的防治体会

目的：探讨腹腔镜脾脏切除术中出血的防治措施。方法：回顾分析哈尔滨医科大学附属第四医院2007年1月—2010年1月开展的63例腹腔镜脾脏切除（LS）患者的临床资料,其中门静脉高压症、脾功能亢进44例,特发性血小板减少性紫癜（ITP）6例,外伤性脾破裂6例,脾恶性淋巴瘤3例,脾血管瘤3例,脾囊肿1例。结果：全部病例均在腹腔镜下完成手术。53例行脾动脉预处理,48例行二级脾蒂法脾切除。手术时间120～200min,平均150min,术中出血150～800mL,平均250mL。结论：脾动脉预处理,二级脾蒂法脾切除是降低术中出血的关键。

Technique to Prevent Bleeding in Laparoscopic Splenectomy

Objective：To investigate the methods to prevent bleeding in laparoscopic splenectomy.Methods：We observed the clinical data of 63 cases after laparoscopic splenectomy in the fourth hospital of Harbin Medical University from January 2007 to January 2010.44 cirrhotic splenomegaly cases,6 idiopathic thrombocytopenic purpura cases,6 spleen traumatic rupture cases,3 spleen malignant lymphoma cases,3 spleen hemangioma cases and one splenic cyst were involved.Results：The laparoscopic procedure was successful in all cases.The splenic artery was ligated and dissected in 53 cases.Amputation of the secondary spleen pedicle was carried out in 48 cases.The operation time averaged 150 min and the average intraoperative blood loss was 250 mL.Conclusion：It is crucial for the intraoperative blood loss control to early perform splenic artery ligation,amputation of the secondary spleen pedicle and comply with minimally invasive concept.