腹腔镜脾部分切除术20例诊治分析

目的:探讨腹腔镜脾部分切除术的安全性及可行性,并总结诊治经验、围手术期处理与体会。方法:回顾分析2012年3月至2018年10月行腹腔镜脾部分切除术患者的临床资料,分析整理临床数据。结果:共入选20例患者,其中男6例,女14例;16~61岁,平均(37.5±14.9)岁。20例手术均成功完成,无一例中转开放手术。手术时间75~280 min,平均(172.0±56.1)min;术中出血量20~300 mL,平均(110.5±75.8)mL。病灶位于脾脏上极13例,脾脏中下极7例。术后病理证实:脾脏囊肿10例,脾血管瘤4例,脉管瘤3例,卵巢癌脾脏转移1例,反应性炎性假瘤2例。随访10~86个月,平均(25.0±8.7)个月,未见复发病例。结论:腹腔镜脾部分切除术是安全、可行的,在切除病灶的同时保留了正常脾脏功能。具体手术方案及术中配合应根据病灶部位、性质、术者习惯等灵活调整。

Retrospective analysis of laparoscopic partial splenectomy:results of 20 consecutive cases

Objective:To investigate the safety,feasibility of laparoscopic partial splenectomy,and summarize the experience of diagnosis and surgical treatment.Methods:Medical records of patients who underwent laparoscopic partial splenectomy between Mar.2012 and Oct.2018 were retrospectively analyzed.Results:A total of twenty patients were involved in this study,including 6 males and 14 females of mean age(37.5±14.9)(16-61)years old.All patients had successful surgical procedures without conversion to open procedures.The mean operation time was(172.0±56.1)min,and the average estimated blood loss was(110.5±75.8)mL.Splenic lesions were confirmed to be located in the superior lobes in 13 cases,and 7 cases in middle or inferior lobes,respectively.For the postoperative pathological findings,cysts were found in 10 cases,hemangiomas in 4 cases,lymphangiomas in 3 cases,ovarian metastatic cancer in 1 case and inflammatory pseudotumor in 2 cases.During the 10-86 months(mean 25.0±8.7)follow-up period,no tumor recurrence was observed.Conclusions:Laparoscopic partial splenectomy is safe and feasible,and this procedure can preserve the normal splenic function at utmost while removing the lesion.The surgical strategy and peri-operative nursing should be adjusted according to the patient’s characteristics,lesion location and surgeons’habits.