全腹腔镜脾切除术107例临床分析

目的:分析总结全腹腔镜脾切除术(laparoscopic splenectomy,LS)的手术技巧与临床应用价值。方法:2006年9月至2012年6月为107例患者行LS,其中外伤性脾破裂出血6例,特发性血小板减少性紫癜(idiopathic thrombocytopenic pur-pura,ITP)7例,自身免疫性溶血性贫血1例,脾囊肿4例,脾血管瘤4例,脾淋巴管瘤3例,脾错构瘤2例,脾结节样增生1例,脾脉管瘤1例,淋巴瘤2例,肝硬化门脉高压脾功能亢进76例。结果:105例成功完成全腹腔镜手术,2例中转开腹。术后2例出血,再次手术探查止血,其中1例经腹腔镜探查止血,1例开腹探查止血。28例联合行胆囊切除术、1例联合行阑尾切除术、3例联合行肝切除术;53例行贲门周围血管离断术。手术时间50～245 min,平均(122.5±55.6)min;术中出血量30～1 000 ml,平均(206.8±212.7)ml;术后住院5～15 d,平均(6.3±2.8)d。结论:LS安全、微创,术中应细致解剖,仔细操作,防止出血并安全有效地处理脾蒂是LS成功的关键。

The clinical analysis of 107 cases of totally laparoscopic splenectomy

Objective：To explore the surgical skills and clinical efficacy of totally laparoscopic splenectomy（LS）.Methods：The clinical data of 107 patients who underwent LS between Sep.2006 and Jun.2012 were retrospectively analyzed.There were 6 cases of traumatic spleen rupture,7 cases of idiopathic thrombocytopenic purpura,1 case of autoimmune hemolytic anemia,4 cases of splenic cyst,4 cases of splenic hemangioma,3 cases of splenic lymphangioma,2 cases of splenic hamartoma,1 case of splenic nodular hyperplasia,1 case of splenic vascular tumor,2 cases of lymphoma,and 76 cases of hypersplenism due to portal hypertension.Results：One hundred and five cases were completed under laparoscopy and 2 cases were converted to open surgery.2 cases had secondary operation for hemostasis because of bleeding after operation,1 case was achieved under laparoscopy successfully,and 1 case underwent open operation.There were 28 cases combined with cholecystectomy,1 case combined with appendectomy,3 cases combined with hepatectomy,53 cases combined with pericardial devascularization.The operating time was 50-245 min,mean（122.5±55.6） min;the intraoperative blood loss was 30-1 000 ml,mean（206.8±212.7） ml;the average postoperative hospital stay was 5-15 d,mean（6.3±2.8） d.Conclusions：Safe and effective management of splenic pedicle is the key point of successful LS.During operation,anatomy and manipulation should be careful to avord hemorrhage.LS is safe,minimally invasive and worthy of promotion.