二级脾蒂结扎速两步离断法在腹腔镜脾切除术中的应用

目的 探讨腹腔镜脾切除术采用结扎速血管闭合系统(LigaSure)二级脾蒂两步离断法处理脾蒂及联合应用超声刀离断脾周韧带的安全性、有效性及经济性.方法 总结分析32例腹腔镜脾切除术应用LigaSure二级脾蒂两步离断法及联合超声刀离断脾周韧带的体会及治疗效果.其中男性4例,女性28例;年龄16～64岁,中位年龄36岁.脾脏长径11～23 cm,平均长径17 cm;特发性血小板减少性紫癜19例、遗传性球形红细胞增多症6例(其中同一家系5例)、溶血性贫血3例、脾外伤血肿感染2例、Evan综合征1例、白血病1例.术中采用LigaSure及超声刀相结合离断脾周韧带,当脾蒂处于充分游离的状态时,采取二级脾蒂LigaSure两步离断法切断脾蒂.第一步在胰尾侧用LigaSure先闭合脾蒂但不切断,第二步于脾侧用LigaSure闭合脾蒂并切断.结果 32例手术均获成功,其中4例家族性遗传性球形红细胞增多症患者同时联合腹腔镜胆囊切除术,无中转手术,平均手术时间70 min(55～130 min),术中平均出血200 ml(50～600 ml),无腹腔出血、无内脏损伤、无胰漏及腹腔感染等并发症,全部治愈出院,平均术后住院6 d.手术免除应用Endo-GIA,平均每例节省手术费用8050元(920～6900元).结论 腹腔镜脾切除术中应用LigaSure二级脾蒂两步离断法处理脾蒂及联合超声刀离断脾周韧带安全可靠,手术时间明显缩短,出血少,且可降低医疗费用,实现了低成本微创外科.     

LigaSure血管闭合系统在腹腔镜脾脏切除术中的应用

目的:探讨LigaSure血管闭合系统在腹腔镜脾脏切除术中的临床应用价值。方法:回顾分析2002年8月至2006年4月利用LigaSure血管闭合系统行腹腔镜脾脏切除术12例患者的临床资料。结果:用LigaSure血管闭合系统闭合处理脾动脉、脾静脉(直径<7mm)2例,丝线结扎加LigaSure血管闭合系统闭合处理脾动脉、脾静脉10例,闭合处理胃短血管、脾结肠、脾肾和脾隔韧带12例,无中转开腹、死亡病例和并发症发生,平均手术时间97min,术中平均失血89ml,患者均于术后1d开始进食,平均住院时间8.4d。结论:在腹腔镜脾脏切除术中,利用LigaSure血管闭合系统闭合处理脾动静脉、胃短血管、脾结肠和脾隔韧带安全可靠,可明显缩短手术时间,减少术中出血。     

腹腔镜脾切除术26例报告

目的探讨腹腔镜脾切除的可行性和临床效果。方法 2005年10月～2011年3月施行26例腹腔镜脾切除术。超声刀离断胃结肠韧带、脾胃韧带和胃短血管,分离脾幼脉,血管夹夹闭。分离脾周粘连、脾胃韧带,并逐支分离脾叶动静脉,血管夹夹闭,离断脾蒂直至切除脾脏。离断小网膜后,超声刀或血管夹离断胃左血管及其以上所有曲张血管,完成门奇静脉断流术。将装入脾脏的标本袋从扩大的戳孔取出。结果 26例均完成LS,无中转开腹手术。手术时间70～250 min,平均142.5 min;术中出血50～3200 ml,平均262.6 ml。术后10～72 h停止胃肠减压,3～5 d拔除引流管。术后住院时间6～15d,平均7.6 d。术后未发生大出血、胰漏,并发胸腔积液3例,肺部感染1例,均经抗炎、理疗及营养支持治疗治愈。结论严格掌握手术适应证,腹腔镜下脾切除术、贲门周围血管离断术安全可行,临床效果好。     

完全腹腔镜下巨脾切除术20例分析

目的探讨腹腔镜巨脾切除术的可行性、安全性及手术技巧。方法回顾性分析2006年8月至2009年7月20例腹腔镜巨脾切除术的临床资料。结果20例均顺利完成腹腔镜巨脾切除术。手术时间100—210min,平均140min。术中出血量20～650ml,平均80ml。术中切除副脾3个,同时行胆囊切除3例,肝活检术9例。全组术后6～12h拔除胃管、尿管并下床活动,12～24h肛门排气,1—2d恢复进食。有1例肝炎后肝硬化患者术后脾窝渗血再次剖腹脾窝止血,无手术死亡。平均住院时间7．8d。结论只要熟练掌握开腹巨脾切除术及腹腔镜技术,腹腔镜巨脾切除术是一种安全可行的微创手术方式,值得临床推广。术中脾周韧带的分离,脾蒂的处理是手术成功的关键因素。     

减少腹腔镜脾切除术术中出血的初步体会

目的探讨预防和减少腹腔镜脾切除术(laparoscopic splenectomy,LS)术中出血的手术技巧和措施。方法2008年1月～2010年3月行LS 40例。脾动脉位于胰尾上缘者,先分离并结扎脾动脉主干,离断脾周韧带;脾动脉位于胰尾后方或胰尾内者,先离断脾周围韧带和剥离胰尾,显露和离断脾蒂血管,完成LS。结果完成LS 31例,LS联合LC 7例,LS联合胆囊切除,贲门周围血管离断术2例。术中切除副脾3例。手术时间90～210 min,平均130 min;出血量50～800 ml,平均160 ml。术后12～24 h胃肠蠕动恢复,术后24 h拔胃管后进食。术后住院5～9 d,平均7.5 d。1例特发性血小板减少性紫瘢(idiopathic thrombocytopenic purpura,ITP)术后效果不佳,血小板一直<50×109/L,口服泼尼松20 mg/d维持治疗;23例ITP随访4个月～2年,平均1年,无复发;2例门脉高压症随访1年,未发生消化道出血。结论围手术期改善凝血,提高血小板计数,术前行脾动脉CT血管造影,手术时在胰腺上缘结扎脾动脉,分离脾周围韧带时避免撕裂脾包膜,妥善处理脾蒂血管,谨慎对待门脉高压症患者,可减少LS术中出血。     

预防腹腔镜脾切除术出血的外科技术要点

目的:探讨预防腹腔镜下脾切除术术中出血的技术。方法:完全腹腔镜手术治疗肝硬化脾肿大6例,特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)5例,脾恶性淋巴瘤3例,脾血管瘤2例,外伤性脾破裂1例。手术步骤包括解剖结扎脾动脉,切断脾周韧带,解剖结扎脾门血管并离断。结果:全部病例均用腹腔镜完成手术。患者均行脾门血管逐条解剖后结扎离断。手术时间50～240min,平均(110±35)min。出血20～1500ml,平均(160±87)ml。结论:完全腹腔镜脾切除术可行,术中早期脾动脉结扎、脾门血管逐条解剖结扎后离断是控制术中出血的关键,紧贴脾实质处理脾蒂可防止胰腺损伤。     

腹腔镜脾切除术32例报告

目的探讨腹腔镜脾切除术（laparoscopic splenectomy，LS）的可行性。方法我院1999年6月-2005年12月行LS32例，超声刀游离脾周韧带，血管切割缝合器离断脾蒂，脾脏装入塑料袋剪碎取出。结果LS成功29例，手术时间60-270min，平均100min；术中出血量30-1000ml，平均230ml。术后住院3—7d，平均5d，无术后并发症。3例中转开腹，1例为脾蒂出血，1例为胃短血管出血，1例为脾周围炎粘连紧密出血。22例特发性血小板减少性紫癜中18例血小板恢复正常，4例术后无升高。2例溶血性贫血术后血红蛋白升高。4例肝炎后肝硬化合并脾功能亢进者术后血小板恢复正常。结论腹腔镜脾切除术安全可行．尤其适合于血液系统疾病中须行脾切除者及脾脏本身病变者。     

腹腔镜脾切除术65例临床研究

目的探讨腹腔镜脾切除术的手术技巧、影响因素及效果。方法回顾性分析本院2003年8月至2008年9月65例腹腔镜脾切除术的临床资料。结果65例中63例顺利完成腹腔镜脾切除术,2例腹腔镜脾切除取出脾脏后脾窝渗血中转小切口开腹脾窝止血,腹腔镜手术成功率达96．9％。手术时间50～180min,平均90min。术中出血量10～600ml,平均60ml。术中切除副脾14个,同时行胆囊切除3例,肝活检术4例。全组术后6～12h拔除胃管、尿管并下床活动,12～24h恢复进食。无并发症发生,无手术死亡,平均住院时间6．2d。结论只要熟练掌握腹腔镜技巧,腹腔镜脾切除术是一种安全可行的微创手术方式,值得临床推广。术中体位的选择,脾周韧带的分离,脾蒂的处理是手术成功的关键因素。     

腹腔镜二级脾蒂离断法脾切除

目的总结腹腔镜二级脾蒂离断法脾切除的应用价值。方法2006年9月～2007年5月,行腹腔镜二级脾蒂离断法脾切除13例,其中外伤性脾破裂出血5例、特发性血小板减少性紫癜2例、肝硬化脾功能亢进6例。结果全部镜下完成,未使用手辅助。手术时间150～300min,平均210min,术中出血50～800ml,平均350ml,术后住院5～9d,平均7.5d,无手术并发症。随访1～6个月,血小板均在正常范围。结论腹腔镜二级脾蒂离断法脾切除术安全、可行、微创。     

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。     

New energy‐based devices in laparoscopic splenectomy: Comparison of Ligasure alone versus Ligasure and Ultracision together

Background: More effective energy‐based haemostatic devices, such as LigaSure and Ultracision, have made laparoscopic solid organ surgery, such as laparoscopic splenectomy (LS), feasible and have facilitated its advancement. The aim of the present study was to compare the effectiveness of Ligasure alone or Ligasure and Ultracision together in LS. Methods: Between February 2007 and August 2010, 25 consecutive adult patients (16 male, 9 female, mean age 35 years) who underwent LS with a wide range of immune trombositopenic purpura (ITP) were studied retrospectively. The patients were evaluated in two groups. The first group of 12 patients was the LigaSure group, and the second group of 13 patients was the LigaSure + Ultracision group. The two groups were compared according to operating time, blood loss and postoperative hospital stay. Groups were well matched according to age, sex, spleen size and weight, body mass index, converting and complication rate. Results: Mean operative time was significantly shorter for the LigaSure + Ultracision group versus the LigaSure group (112.3 vs 147.5 min; P = 0.002). Mean intraoperative blood loss was slightly lower for the LigaSure + Ultracision group vs the LigaSure group, but it was not statistically significant (122.3 vs 142.5 mL; P = 0.219). There was no significant difference in mean postoperative hospital stay for both groups (2.3 vs 2.9 days; P = 0.093). Conclusion: LS must be the first choice for removal of the spleen, particularly for benign haematological disorders. One of the most important factors to achieve advanced laparoscopic surgery, such as LS, is new energy‐based devices, such as LigaSure and Ultracision. Using LigaSure and Ultracision together in LS reduces the operating time.     

Laparoscopic splenectomy in a general surgery department of a hospital

The results of treatment of 32 patients with spleen diseases who have undergone laparoscopic splenectomy (LSE) are analyzed. Surgery was performed most often for idiopathic thrombocytopenic purpura. Some technical features of surgery are discussed. It is demonstrated that high-technology methods (suturing device "EndoGia", electrosurgical unit "LigaSure") increase reliability of hemostasis, decrease blood loss during surgery and reduce time of surgery. Complications during surgery were seen in 3 (9.3%) cases, conversion - in 2 (6.3%). Mean time of surgery was 121.3 min, mean blood loss - 346 ml, postoperative complications were seen in 4 (12.5%) patients, mean hospital stay - 5.7 days. There were no lethal outcomes. It is concluded that LSE is safe and effective procedure reducing rate of infectious and hemorrhagic complications after surgery.     

腹腔镜脾切除术44例临床分析

目的：总结腹腔镜脾切除术的经验体会。方法：2006年9月至2009年10月行腹腔镜脾切除术44例,其中外伤性脾破裂出血6例,特发性血小板减少性紫癜3例,自身免疫性溶血性贫血1例,脾囊肿4例,脾血管瘤2例,脾淋巴管瘤1例,脾错构瘤2例,肝硬化门脉高压脾功能亢进25例。均采用二级脾蒂离断法。结果：43例成功完成腹腔镜手术,1例行开腹手术。手术时间55~240min,平均（126.40±52.43）min,术中出血30~1 000ml,平均（221.7±214.43）ml,术后住院5~15d,平均6.5d,1例脾错构瘤由于术后短时间引流量多,引流液色红而再次行腹腔镜探查,发现为取脾时意外撕裂大网膜导致出血,腹腔镜下成功止血。术后无死亡病例。结论：腹腔镜二级脾蒂离断法脾切除术安全、可行、微创、经济。     

Laparoscopic Splenectomy Using LigaSure

Background:

Laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases. Bleeding is the main complication and cause for conversion. We present our experience with the LigaSure and discuss its advantage as a vessel sealing system in achieving safe vascular control.

Method:

Over a 3-year period, we performed 12 consecutive LS using LigaSure at a single center. A literature review of all the patients who had undergone laparoscopic splenectomy with of the LigaSure to achieve vascular control at the hilum was carried out, assessing its advantages and outcome.

Results:

Twelve LS were performed. Eleven of these patients had ITP, and one patient had sickle cell disease. The mean blood loss was 70mL (range, 50 to 460), and operating time was 126 minutes (range, 110 to 240). Two postoperative complications occurred: portal vein thrombosis in one case and subphrenic collection in the other. The literature review revealed 8 studies with 231 cases in which the LigaSure was used to perform laparoscopic splenectomy. A significant reduction in operating time (average 102 minutes) and intraabdominal blood loss (66mL) was observed with the LigaSure compared with endostaplers.

Conclusion:

The use of LigaSure and the semilateral position results in a gain of time and safety in addition to low intraoperative bleeding, need for transfusion, minimal complications and a low conversion rate.     

Single Incision Laparoscopic Splenectomy in a 5-Year-Old With Hereditary Spherocytosis

Background:

Single incision laparoscopic surgery (SILS) is an emerging technique that has been used as an approach for appendectomy, cholecystectomy, and splenectomy. We describe the technique of single incision laparoscopic splenectomy for hypersplenism in a 5-year-old boy with spherocytosis.

Case Report:

The patient required blood transfusions for anemia secondary to hypersplenism. His spleen measured 9.8 cm in cranio-caudal length on ultrasound. SILS splenectomy was performed through a 2-cm umbilical incision by using 3 ports. The splenic attachments were taken down using an electrosurgical sealing and cutting device, and the hilum was transected with an endosurgical stapler. The spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision without complications. Operative time was 84 minutes; blood loss was minimal.

Conclusion:

SILS splenectomy is feasible in pediatric patients. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.     

腹腔镜门脉高压症巨脾切除术脾蒂的处理体会

目的:探讨手助腹腔镜下巨脾切除的脾蒂处理方法和技术。方法:2003年2月~2006年3月共完成手助腹腔镜门脉高压症巨脾切除术33例。脾蒂的处理方法如下:直线切割缝合器23例,直视下结扎4例,血管闭合器(L igaSure)2例,钛夹2例,腔镜下结扎2例。结果:33例手术全部成功处理脾蒂,未发生脾蒂大出血。手术时间150~260m in,平均190m in。术中出血100~2 000m l,平均490m l。切除脾重500~2 000g,平均910g。术后32例恢复顺利,1例因肝功能衰竭死亡。结论:腔镜下巨脾切除术脾蒂处理十分关键,直视下结扎和应用直线切割缝合器处理脾蒂最为安全、有效。     

Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome

INTRODUCTION: Although laparoscopic splenectomy has become the preferred treatment of choice for hematologic-related splenic disorders, intraoperative blood loss remains a common occurrence. In an effort to reduce this risk, we evaluate the potential role and clinical outcome of concomitant intraoperative splenic artery embolization and laparoscopic splenectomy. METHODS: Between June 2000 and July 2005, 18 patients with hematologically related splenic disorders underwent combined intraoperative splenic artery embolization and laparoscopic splenectomy (group 1). For comparison, we studied 18 age- and gender-matched case controls undergoing same operations during the same period (group 2). Intraoperative data and clinical outcome were compared between the 2 groups. RESULTS: Technical success was 100% in group 1. One patient in group 2 was converted to open splenectomy because of severe blood loss, resulting in a technical success rate of 95%. The mean splenic size in group 1 and group 2 was 15.5 +/- 4.7 cm (range, 12-23 cm) and 15.7 +/- 6.8 (range, 11-24 cm), respectively (not significant [NS]). Mean operative time in group 1 and group 2 was 175 minutes and 162 minutes, respectively (NS). Significantly less intraoperative blood loss was noted in group 1 (mean, 25 mL; range, 15-63 mL) compared with group 2 (mean, 240 mL; range, 150-420 mL; P < .003). There was an even greater difference in blood loss between the 2 groups when the splenic size was greater than 18 cm (mean 35 mL in group 1 versus 350 mL in group 2, P < .001). No differences were noted in postoperative recovery, return of bowel function, or length of hospital stay between the 2 groups. CONCLUSIONS: Concomitant splenic artery embolization and laparoscopic splenic reduced operative blood loss when compared with laparoscopic splenectomy procedure alone. Splenic artery embolization is a useful intraoperative adjunctive procedure that should be considered in patients undergoing laparoscopic splenectomy for hematologic disorders who are Jehovah's Witness or with significant hypersplenism because of benefit of reduced blood loss.     

同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化性脾功能亢进的初步研究

目的 探讨同步腹腔镜肝切除联合脾切除术治疗原发性肝癌并发肝硬化性脾功能亢进的安全性和临床疗效.方法 对中南大学湘雅医学院附属株洲医院2017年1月至2020年6月间接受同步腹腔镜肝切除联合脾切除术的原发性肝癌并发肝硬化性脾功能亢进的15例患者临床资料进行回顾性分析,统计患者的客观缓解率、手术情况、术后并发症发生率、术后...