切割闭合器及抬脾技术在腹腔镜脾切除术中的应用

目的探讨使用切割闭合器及抬脾技术进行腹腔镜脾切除术的可行性、安全性及操作方法等。方法回顾性分析28例采用切割闭合器及抬脾技术行腹腔镜脾切除术病例的临床资料,其中原发性血小板减少性紫癜(ITP)6例,遗传性球形红细胞增多症(HS)7例,地中海贫血(MA)3例,溶血性贫血2例,外伤性脾破裂2例,肝硬化脾亢8例。结果 28例手术均在腹腔镜下完成,无中转开腹病例。手术时间(89.5±3.5)min,术中出血(27.1±21.2)ml,术后肛门排气时间(1.5±0.7)d,术后住院时间(5.04±0.71)d。无术后感染、胃肠瘘、胰瘘发生。有6例患者术后血小板≥500×109/L,给予口服阿司匹林,无动静脉血栓形成发生。结论使用切割闭合器及抬脾技术行腹腔镜脾切除术简单、安全、有效,缩短了手术时间,减少了术中、术后并发症的发生。

The application of endostapler and carrying spleen technology in laparoscopic splenectomy

Objective To investigate the feasibility, safety and operation method of endostapler and carrying spleen technology in laparo- scopic splenectomy. Methods Clinical data of 28 patients undergoing laparoscopic splenectomy with endostapler and carrying spleen technology from May 2011 to October 2012 were analyzed retrospectively. Six patients presented with idiopathic thrombocytopenic purpura, 7 patients with he- reditary spherocytosis, 3 patients with thalassemia, 2 patients with hemolytic anemia, 8 patients with hypersplenism associated with liver cirrhosis. Results All these cases underwent laparoscopic splenectomy. No patients converted to lapraotomy. The average operation time was （ 89.5 ± 3.5 ） min. The mean intraoperative blood loss amount was （27.1 ± 21.2 ） ml. The postoperative anal exhaust time was （1.5 ± 0.7 ） d. The postopera- tive hospital stays was （5.0 ± 0.71 ） d. No postoperative infection, gastrointestinal fistula, pancreatic fistula was reported. The postoperative plate- let number was more than 500× 109/L in six patients. No arteriovenous thrombosis occurred after oral aspirin. Conclusion Using endostapler and carrying spleen technology in laparoscopic splenectomy is simple, safe, effective operation method. The operation time is shorten than before. The intraoperative and postoperative complication is reduced.