二级脾蒂结扎速两步离断法在腹腔镜脾切除术中的应用

目的 探讨腹腔镜脾切除术采用结扎速血管闭合系统(LigaSure)二级脾蒂两步离断法处理脾蒂及联合应用超声刀离断脾周韧带的安全性、有效性及经济性.方法 总结分析32例腹腔镜脾切除术应用LigaSure二级脾蒂两步离断法及联合超声刀离断脾周韧带的体会及治疗效果.其中男性4例,女性28例;年龄16～64岁,中位年龄36岁.脾脏长径11～23 cm,平均长径17 cm;特发性血小板减少性紫癜19例、遗传性球形红细胞增多症6例(其中同一家系5例)、溶血性贫血3例、脾外伤血肿感染2例、Evan综合征1例、白血病1例.术中采用LigaSure及超声刀相结合离断脾周韧带,当脾蒂处于充分游离的状态时,采取二级脾蒂LigaSure两步离断法切断脾蒂.第一步在胰尾侧用LigaSure先闭合脾蒂但不切断,第二步于脾侧用LigaSure闭合脾蒂并切断.结果 32例手术均获成功,其中4例家族性遗传性球形红细胞增多症患者同时联合腹腔镜胆囊切除术,无中转手术,平均手术时间70 min(55～130 min),术中平均出血200 ml(50～600 ml),无腹腔出血、无内脏损伤、无胰漏及腹腔感染等并发症,全部治愈出院,平均术后住院6 d.手术免除应用Endo-GIA,平均每例节省手术费用8050元(920～6900元).结论 腹腔镜脾切除术中应用LigaSure二级脾蒂两步离断法处理脾蒂及联合超声刀离断脾周韧带安全可靠,手术时间明显缩短,出血少,且可降低医疗费用,实现了低成本微创外科.

The value of spleen subpedicle two steps severance with LigaSure in laparoscopic splenectomy

Objective To evaluate the safety and utility of the Methods of spleen subpedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect perisplenic ligaments during laparoscopic splenectomy. Methods The Methods and the curative effect of 32 patients with laparoscopic splenectomy performed by the way as mentioned above were summarized and analyzed. 4 males,28 females,median 36 years(range 16-64 years). Mean dimensions of spleens were 17 cm(range 11-23 cm). Ninteen patients had idiopathic thrombocytopenia purpura (ITP), 6 hereditary spherocytosis (HS)(5 of them were the same family constellation),3 hemolytic anemia (HA),2 spleen injury with haematoma infection, 1 Evan syndrome, 1 leukemia.Perisplenic ligaments were resected by LigaSure combined with ultrasound scalpel, splenic pedicle was resected by spleen subpedicle two steps severance with LigaSure when splenic pedicle were sufficiently free. Splenic pedicle was nonexcisional occluded by LigaSure at pancreatic cauda, in the first step and was occluded and resected alongside of the spleen in the second step. Results All of the 32 cases were completely succeed, the average operating time was 70 min (55-130 min),the estimated introperative blood loss was 200 ml (50-600 ml), no complications such as abdominal haemorrhage, visceral injury, pancreatic leakage and infection were observed. All the patients were healed well, the average hospital stay after an operation was 6 days. The average expense of each patients could save 8050 yuan because Endo-GIA was not used. Conclusions Spleen subpedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect perisplenic ligaments during laparoscopic splenectomy,which shorten the operating persistence time with less bemorrage is a safe, effective and low-cost minimally invasive sugery in selective cases.