腹腔镜与手助腹腔镜脾切除术的临床应用

目的探讨腹腔镜与手助式腹腔镜脾切除术的方法、安全性和有效性。方法需行脾切除术的患者26例，包括肝硬化继发性脾功能亢进13例，原发性血小板减少性紫癜6例，外伤性脾破裂4例，假性脾囊肿1例，遗传性红细胞增多症2例。脾亢患者中有8例接受手助式腹腔镜脾切除术，8例中有5例同时行贲门周围血管离断术，4例脾外伤行手助式腹腔镜脾切除术，其余14例患者均采用腹腔镜脾切除术。结果除1例因大出血而中转开腹，余25例顺利完成手术，术中出血量约200～400mL，平均手术时间约为2．5～4．0h，平均术后5～9d出院，无手术并发症。结论腹腔镜及手助式腹腔镜脾切除术安全可行，创伤小，恢复快，值得临床推广。

Clinical application of laparoscopic splenectomy and hand assisted laparoscopic splenectomy

[Objective] To explore the methods, safty and efficacy of laparoscopic splenectomy (LS) and hand-assisted laparoscopic splenectomy (HALS). [Method] 26 cases underwent splenectomy, including 13 cases of hypersplenism secondary to hepatic cirrhosis, 6 cases of idiopathicthrombo cytopenicpurpura, 4 cases of ruptured spleen, 1 case of pseudocyst of spleen, 2 cases of hereditaryspherocytosis. 8 cases of hypersplenism secondary to hepatic cirrhosis were underwent HALS, 5 cases of them underwent HALS combined with portozygos disconnection, 4 cases of ruptured spleen underwent HALS, other 14 cases underwent LS. [Result] One case were shifted to open surgery, LS or HALS were successful in 25 cases with average time from 2.5 to 4 hours, the blood loss from 200 to 400ml, the average postoperative hospital stay from 5 to 9 days, all cases without postoperative complication. [Conclusion] Lapaoroscopic splenectomy and hand-assisted laparoscopic splenectomy is feasible, effective, safe and minimally invasive.