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。

Clinical analysis of 20 patients undergoing laparoscopic megasplenectomy

Objective To evaluate the feasibility, safety, and surgical techniques of laparoscopic megaspleneetomy （LMS）. Methods The clinical data of 20 patients undergoing LMS between August 2006 and July 2009 were retrospectively analyzed. Results The operative time ranged from 100 to 210 minutes （averagel40minutes）. Blood loss during the operation ranged from 20 to 650 ml （average 80 ml）. Accessory splenectomy was performed in 3 patients , laparoseopic choleeystectomy in 3, and liver biopsy in 9. After gastric tube and urinary catheter were removed in these patients, proper off-bed activities were done 6-12 hours, anus exhaust started after 12-24 hours, and food intake resumed after 1-2 days. One patient with liver cirrhosis underwent an operation for spleen bleeding. No death occurred during the operation. The mean postoperative hospitalization was 7.8 days. Conclusions LMS is a sort of safe and minimally invasive surgery and worth popularizing when laparoseopic operation or open megasplenectomy was mastered. The proper dissection of peri-splenic ligaments and treatment of splenic pedicle are the key to a successful operation.