腹腔镜脾切除术失败原因及应对措施的分析

目的：总结腹腔镜脾切除术中导致手术失败的原因，并探讨其应对措施。方法：分析2001年9月至2013年6月腹腔镜脾切除术失败的31例患者的临床资料，总结其应对措施。结果：失败原因：器械原因1例，术中钛夹遗失1例，腹腔严重粘连3例，胃体部副损伤1例，术中显露脾脏困难9例，术中、术后出血15例，术后切口延期愈合1例。结论：术中显露困难、术中术后出血是导致腹腔镜脾切除术失败的主要原因，同时术中防止其他意外情况也尤为重要。术者应选择合适的病例，完善术前准备，强调术中精准操作，总结经验，以减小腹腔镜脾切除术失败的可能性。

Analysis about the failed reason of laparoscopic splenectomy and its countermeasures

Objective：To summarize the reasons leading to unsuccessful laparoscopic splenectomy （LS） and discuss its countermeasures. Methods：The clinical data of 31 patients who underwent the unsuccessful LS from Sep. 2001 to Jun. 2013 were analyzed, the difficuhies in surgery were discussed and the solutions for making success were summarized. Results：The failure reasons included 1 case of intraoperative breaking Endo-GIA, 1 case of lost Titanium clip during operation,3 cases of severe abdominal adhesion, 1 case of secondary damage to body of stomach,9 cases of poorly intraoperative exposure, 15 cases of intraoperative or postoperative bleeding and 1 case of delayed healing of incision. Conclusions： Poorly intraoperative exposure, intraoperative and postoperative bleeding are main reasons leading to unsuccessful LS, and it is important to prevent accidents. Surgeons should choose appropriate patients, improve preoperative preparation, emphasize the precise operation proceedings, and summarize experiences to reduce the possibilities of failure in LS.