免内镜切割闭合器的腹腔镜脾切除术14例报告

目的探讨免内镜切割闭合器的腹腔镜脾切除术的可行性。方法11例特发性血小板减少性紫癜、1例自身免疫性溶血性贫血、1例脾脏脉管瘤和1例脾功能亢进、乙肝后肝硬化病人行免内镜切割闭合器的腹腔镜脾切除术。结果14例患者手术均获成功，手助术式1例。二级脾蒂离断法处理脾蒂2例，圈套器双重结扎法处理脾蒂12例。手术时间80-400min，平均180min。术中出血量20～2000mL，平均350mL。术后住院时间2～21d，平均7d。手术并发症2例（14．29％），其中皮下气肿1例，左侧腹壁广泛淤斑1例。结论腹腔镜脾切除术中通过二级脾蒂离断法或圈套器双重结扎法处理脾蒂，可免内镜切割闭合器的使用，该术式安全、有效。

Laparoscopic Splenectomy Without Using Endo-GIA: Report of 14 Cases

Objective To explore the feasibility of laparoscopic splenectomy(LS) without using Endo-GIA.Methods Fourteen cases underwent LS without using Endo-GIA,including 13 idiopathic thrombocytopenic purpura and 1 autoimmune hemolytic anemia and 1 splenic hemangioma and 1 hypersplenism.Results All operations were successful including one hand-assisted laparoscopic splenectomy.There were 2 cases operated on using dissection secondary branches of splenic pedicle and 12 using the snare to deal with the splenic hilus.The average operating time was 180 min(80~400 min) and the mean intraoperative blood loss was 350mL(20~2 000 mL).The average postoperative hospital stay was 7 days(2~21days).Postoperative complication occurred in 2 cases(14.29%),including one subcutaneous emphysema and one left lateral abdominal wall diffuse ecchymosis.Conclusion It is a safe and effective procedure to use dissection secondary branches of splenic pedicle or the snare to deal with the splenic hilus in LS.It is possible to perform LS without using EndoGIA by the two techniques.