腹腔镜脾切除术的并发症及其防治

目的 探讨腹腔镜脾切除术（laparoscopic splenectomy,LS）的并发症以及防治方法.方法 78例LS患者,其中特发性血小板减少性紫癜24例,溶血性贫血5例,脾囊肿6例,脾血管瘤4例,外伤性脾血肿6例,肝硬化脾功能亢进33例.术前行脾脏64排CT血管造影（CTA）检查,回顾性研究LS的并发症并进行总结.结果 78例LS中转开腹5例,1例进行二次剖腹探查手术,3例脾窝感染和2例胰瘘,迟发型胃瘘1例,脾组织残留1例,无术后严重并发症.结论 LS在经过30例以上的经验积累,其并发症可以显著的减少,精细的二级脾蒂分离技术是保证手术安全的操作基础.只要经验足够,LS是一种安全有效的首选方法.

The complication of laparoscopic splenectomy and its preventinon and treanment

Objective To investigate the complication of laparoscopic splenectomy （LS）,and is prevention and treatment.Methods LS was performed in 78 patients,who had been performed 64 row CTA before operation.Basing on outcomes of operation record,we estimated the complications fo LS and investigate the rensaon,prevention,and treatment.Results In all the 78patients,5 was converted to OS.1 was laparotomied again.3 with splenic fossa infention.2 with pancreatic fistula.1with de layed gastric fistula.no severe postoperative complication.Conclusions After 30 cases were performed,the complications were reduced greatly.Precisely secondary branches of splenic pedicle,is the base of opera ton safety.If Precisely performed basing on our experience,LS is safe and effective first choice.