二级脾蒂离断术在外伤性脾破裂脾切除术中的应用

目的 分析研究二级脾蒂离断术在外伤性脾破裂脾切除术中的临床疗效.方法 选自我院2008年10月至2011年10月收治的102例外伤性脾破裂患者.将所有患者随机地分为研究组(二级脾蒂离断术组)和对照组(传统脾蒂离断术组)各51例.比较两组患者的手术时间、术中出血量及术后并发症的情况.结果 对照组患者的手术时间为(52.18±0.24) min,术中出血量为(137.48±10.74) ml;研究组患者的手术时间为(56.47±1.21) min,术中出血量为(144.74±11.03) ml,且两组比较差异无统计学意义(t=4.31、3.82,P＞0.05).研究组术后来出现并发症;对照组患者术后有2例出现脾蒂继发性出血,4例出现胰瘘,8例出现脾热,术后并发症的发生率为27.45％.两组患者的术后并发症发生率比较差异有统计学意义(x2=16.23,P＜0.05).结论 二级脾蒂离断术与传统的脾蒂离断术比较,手术时间与术中出血量差异无统计学意义,术后并发症发生率低,临床疗效确切,值得在临床推广.     

腹腔镜引导下二级脾蒂离断切脾术治疗创伤性脾破裂的效果

目的研究腹腔镜引导下二级脾蒂离断切脾术治疗创伤性脾破裂的效果。方法选取2017年6月至2019年5月洛阳东方医院收治的64例创伤性脾破裂患者,按随机数表法分为开腹组(32例)和腹腔镜组(32例)。开腹组接受开腹脾切除手术治疗,腹腔镜组接受腹腔镜引导下二级脾蒂离断切脾术治疗。对比两组围手术期基本情况(脾动脉结扎用时、术中失血量、术后排气时间、术后引流管滞留时间、住院天数)、并发症发生率。结果腹腔镜组脾动脉结扎用时、术后排气时间、术后引流管滞留时间及住院天数较开腹组短,术中失血量较开腹组少(均P<0.05)。开腹组并发症发生率为25.00%(8/32),腹腔镜组并发症发生率为6.25%(2/32)。腹腔镜组并发症发生率较开腹组低,差异有统计学意义(P<0.05)。结论腹腔镜引导下二级脾蒂离断切脾术治疗创伤性脾破裂,能明显降低术中失血量和并发症发生率,缩短术后康复时间。     

腹腔镜原位二级脾蒂离断脾切除术在基层医院的应用

目的：探讨腹腔镜原位二级脾蒂离断脾切除术在基层医院的应用效果。方法选取2012年3月—2013年5月于我院行腹腔镜原位二级脾蒂离断脾切除术的6例患者,对其手术方式和术后恢复各项指标进行回顾性分析。结果6例腹腔镜原位二级脾蒂离断脾切除术均获成功,术后无胰瘘、出血等并发症。结论腹腔镜原位二级脾蒂离断脾切除术是安全可行的,具有创伤小、恢复快、并发症少等优点,同时手术费用降低,有很大的临床推广价值。     

腹腔镜下二级脾蒂离断法脾切除术16例分析

目的总结分析腹腔镜下二级脾蒂离断法脾切除术的临床应用价值。方法 16例患者行腹腔镜下二级脾蒂离断法脾切除术,其中特发性血小板减少性紫癜8例,多发性脾囊肿2例,脾血管瘤3例,门脉高压脾功能亢进3例。结果除一例脾功能亢进患者血管较粗,术中血管损伤破裂出血,腔镜下止血效果欠佳后中转开腹,其余15例手术均在腹腔镜下完成,术后均未见大出血、胰瘘、膈下脓肿等严重并发症发生,无切口感染病例。结论腹腔镜下二级脾蒂离断法脾切除术安全有效,减轻了患者痛苦,缩短了住院时间,值得临床应用推广。     

31例腹腔镜下脾切除的临床分析

目的：探讨完全腹腔镜下脾切除的手术技巧和临床经验。方法回顾性分析该院从2003年1月至2015年4月进行完全腹腔镜脾切除术31例,其中,肝硬化脾功能亢进12例,脾多发性血管瘤5例,脾淋巴瘤3例,脾囊肿3例,陈旧性脾破裂、脾血肿2例,特发性血小板减少症6例,术中LigaSure处理脾胃韧带,结扎脾动脉,采用丝线结扎或腔内直线切割闭合器个体化处理脾蒂。结果31例腹腔镜脾切除术,无中转开腹患者。其中,13例逐一分离、丝线结扎脾门血管后离断脾蒂,18例采用腔内直线切割闭合器离断脾蒂,手术时间80～240 min ,平均（130±35）min ,术中出血量60～500 mL ,平均（150±80）mL ,平均住院时间8．3d,无手术死亡及胰瘘并发症发生病例。结论在开腹脾切除的基础上,术前仔细评估,选择合适病例,利用不同腹腔镜器械的优势,个体化方式处理脾蒂,腹腔镜脾切除术安全实用。     

腹腔镜下二级脾蒂离断法脾切除术的应用

目的 探讨腹腔镜下二级脾蒂离断法脾切除术的临床应用。方法腹腔镜下采用二级脾蒂离断法行脾切除治疗特发性血小板减少性紫癜（ITP）9例,均用四孔法,先离断胃短血管,结扎脾动脉,离断脾周韧带,近脾门解剖二级脾蒂,从脾下极向脾上极逐支结扎离断脾叶血管,切除脾脏。结果9例全部在腹腔镜下完成,其中5例早期结扎脾动脉,手术时间110～320分钟,平均用时170分钟,出血量80～650ml,平均280ml,住院时间6～10天,平均7．5天,无脾切除热、腹腔出血、胰漏等并发症发生。结论腹腔镜下采用二级脾蒂离断法脾切除术,避免了大块结扎、离断脾蒂,减少了脾切除热发生,避免了胰腺尾部的损伤,对于治疗血液病致脾肿大是安全可靠的。     

腹腔镜引导二级脾蒂离断切脾术在创伤性脾损伤患者中的临床效果和价值

目的 探讨与研究腹腔镜引导二级脾蒂离断切脾术在创伤性脾损伤患者中的临床效果和价值,旨在为临床治疗此类疾病提供参考依据.方法 研究对象为空军军医大学第一附属医院2016年5月-2019年5月期间收治的创伤性脾破裂患者共54例,依据患者手术方式不同分为观察组和对照组,每组27例.对照组应用常规开腹脾切除手术治疗,观察组应用...     

二级脾蒂离断法脾切除术在肝硬化脾功能亢进中的应用

目的：探讨肝硬化脾功能亢进轻中度脾肿大行腹腔镜下二级脾蒂离断法脾切除术的可行性、有效性和安全性。方法：对2009年1月至2010年12月施行腹腔镜下二级脾蒂离断法行脾切除治疗肝硬化脾功能亢进轻中度脾肿大25例患者的临床资料进行回顾分析。结果：除1例因大出血中转开腹外,均顺利完成手术。手术时间平均180 min,术中平均出血量260 mL,无严重并发症。结论：肝硬化脾功能亢进轻中度脾肿大患者行腹腔镜下二级脾蒂离断法脾切除安全有效,并可降低手术费用,值得临床推广。     

不同手术方法治疗创伤性脾破裂临床疗效观察

目的探讨不同手术方法治疗创伤性脾破裂的临床疗效。方法将我院2007年8月至2010年8月创伤性脾破裂患者42例分为两组：观察组和对照组。观察组患者采用脾动脉栓塞治疗,采用改良Seldinger穿刺方法,将导管选择性的插入出血部位的脾叶脾动脉进行栓塞,直到出血停止。对照组采用脾破裂修补术,根据脾破裂情况实施单纯修补缝合、脾修补联合大网膜填塞术、脾部分切除联合大网膜填塞修补术。观察两组患者术后并发症的发生情况。结果两组患者手术均成功。观察组患者术后2例出现左侧胸腔积液,并发症发生率为9.5%（2/21）;对照组患者术后发生不完全性肠梗阻5例,肺部合并感染3例,泌尿系感染3例,合并伤口感染1例,对照组并发症发生率为57.1%（12/21）。两组患者并发症发生率比较差异有统计学意义（P〈0.05）。结论脾动脉栓塞术和脾破裂修补术治疗脾破裂均能获得良好手术效果,但脾动脉栓塞术的术后并发症较少。     

脾保留手术治疗创伤性脾破裂的临床探讨

目的：分析脾保留手术治疗创伤性脾破裂的疗效。方法选取该院2011年6月—2014年6月收治的创伤性脾破裂患者，共计56例，分为两组，各28例，对照组进行脾切除手术，研究组进行脾保留手术。结果研究组临床有效率为92.86%，对照组临床有效率为78.57%；术后并发症发生率研究组为10.71%、对照组为28.57%。结论脾保留手术治疗创伤性脾破裂的疗效显著，恢复快，并发症少，在患者伤情允许情况下优先选择脾保留术。     

外伤性脾破裂的保守性手术治疗：附24例报告

本文报告因外伤性脾破裂行脾保留手术24例,均获成功。其中单纯脾修补12例,脾修补加脾动脉结扎6例,半脾切除2例,半脾切除加脾动脉结扎1例,脾切除后自体脾组织移植3例。同时对手术方法和手术适应证进行了讨论。     

Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy

Background It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here, we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy. Methods We retrospectively compared and analyzed the complications, postoperative hospital stay, operative time, and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007. The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle. In addition, we analyzed the relationship between size of the spleen and occurrence of complications. Results The incidence of pancreatic fistula and splenic fever （0/70 and 9/70） was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group （5/51 and 18/51 respectively）. In addition, there was no significant difference in operative time and volume of blood loss between two groups. The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications. Conclusions These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula, and shorten the postoperative hospital stay, especially in the patients with a large spleen. So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.     

外伤性脾破裂的保脾手术治疗

目的探讨外伤性脾破裂保脾手术治疗的方法及效果。方法回顾性分析外伤性脾破裂32例保脾手术治疗的临床资料,18例行修补缝合术,9例行脾部分切除术,5例行脾动脉结扎+脾部分切除术。随访时间1a~3a。结果本组无手术死亡病例,全部治愈出院,术后恢复劳动能力,无感染易感性增加。B超检查脾动脉结扎者无脾梗死情况。结论对部分外伤性脾破裂患者,综合运用保脾手术是安全有效的。     

严重创伤性脾破裂31例保脾手术治疗

目的探讨严重创伤性脾破裂保脾手术治疗的方法及效果.方法回顾性分析严重创伤性脾破裂31例保脾手术治疗的临床资料,6例行脾动脉结扎 修补缝合术,13例行脾动脉结扎 部分切除术,12例行脾切除 大网膜自体脾组织移植术.全部获得随访,随访时间1～5年.结果本组全部治愈出院,无手术死亡病例.术后均恢复劳动能力,无感染易感性增加,B超检查提示:脾动脉结扎者无脾梗死情况,脾切除 大网膜自体脾组织移植者在移植部位可见脾组织回声波.结论对严重创伤性脾破裂病例,行脾动脉结扎 修补缝合或部分切除术是可行的,即能迅速有效地控制脾破裂出血,又能维持脾脏功能.脾切除 大网膜自体脾组织移植术是全脾切除术后弥补脾功能的有效方法.     

外伤性延迟性脾破裂17例临床分析

目的:探讨外伤性延迟性脾破裂的外科手术疗效。方法:手术治疗17例,脾切除10例,单纯脾修补5例,脾动脉结扎+脾部分切除2例。结果:治愈16例,病死1例。结论:对于外伤性延迟性脾破裂应提高警惕性,密切观察病情变化,及时明确诊断,治疗仍以手术治疗为主,保脾治疗亦应受到重视。     

Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

Background Laparoscopic splenectomy （LS） is currently the standard approach for resection of a normal-sized spleen. However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging （CDFI） in splenic vessel anatomy and evaluated its value for LS.
Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size （CDFI group）. In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed （non-CDFI group）. Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student＇s ttest.
Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the constituent ratios of the parameters by CDFI and those by intraoperative telerecording in the CDFI group （χ^2=0.383, 1.072, 0.119, P=0.536, 0.784, 0.730）. However, statistically significant differences were observed in the operative time （（158.70±42.51） minutes vs （200.65±47.89） minutes, P=0.003）, intraoperative blood loss （（55.87±17.36） ml vs （101.83±62.21） ml, P=0.001）, and recovery time of gastrointestinal function （（24.39±8.88） hours vs （30.60±9.45） hours, P=0.024） between the groups. Conclusions The individual operative route and schedule can be successfully determined on the basis of various kinds of reproducible anatomic frameworks of the spleen provided by preoperative CDFI. This technique facilitates the surgical procedure, shortens the operative time, reduces intraoperative blood loss and decreases the risk of LS in splenomegaly cases.     

利用脾周韧带原位保脾手术治疗严重损伤性脾破裂13例

目的探讨利用脾周韧带侧支循环行部分原位保脾治疗严重损伤性脾破裂的可行性。方法对13例脾门严重损伤性脾破裂患者行脾蒂结扎,保留上或／和下极、不规则脾大部切除术。结果手术均获成功,无术后并发症,残脾功能恢复良好。结论利用脾周韧带作部分原位保脾治疗脾门严重损伤性脾破裂是可行的。     

选择性脾动脉栓塞术治疗外伤性脾破裂临床分析

目的比较选择性脾动脉栓塞术与脾切除术治疗外伤性脾破裂的临床应用。方法回顾分析16例选择性脾动脉栓塞和42例手术治疗的外伤性脾破裂患者的临床资料。结果 12例Ⅰ、Ⅱ级损伤选择性脾动脉栓塞的患者均保脾成功,4例Ⅲ级以上脾破裂行选择性脾动脉栓塞的患者有2例转为开腹手术,选择性脾动脉栓塞成功率为87.5%（14/16）。选择性脾动脉栓塞成功的患者平均住院时间（7.5±2.0）d,开腹手术患者平均住院时间（12.3±3.6）d。58例中治愈56例,死亡2例。结论脾脏Ⅰ、Ⅱ级损伤采用保脾治疗,以选择性脾动脉栓塞术为主,Ⅲ级以上脾破裂以脾切除术为主。     

脾动脉结扎带蒂大网膜覆盖或填塞行保脾手术17例体会

目的探讨外伤性脾破裂保脾手术方式。方法对17例外伤性脾破裂采用脾动脉结扎带蒂大网膜填塞脾破裂口缝合修补治疗。结果手术保脾治疗17例,其中单纯修补缝合3例,脾修补缝合加大网膜填塞5例,脾部分切除加大网膜填塞修补9例,术后均未出现再出血等并发症,经1~3年随访,B超、CT扫描脾解剖形态未见异常。结论该手术方法操作简单,效果满意,是较理想的保脾手术方法。