经脐单孔腹腔镜下二级脾蒂离断法行脾切除的临床应用

目的:探讨经脐单孔腹腔镜下二级脾蒂离断法行脾切除的临床应用价值。方法:回顾分析2012年6月至2013年8月为30例患者行腹腔镜下二级脾蒂离断法脾切除术的临床资料。将患者分为单孔腹腔镜组与三孔腹腔镜组,对比分析两组患者术中、术后情况。结果:术后无严重并发症发生。单孔腹腔镜组2例中转单手辅助腹腔镜手术;13例门静脉高压性脾功能亢进患者加行腹腔镜胃底贲门周围血管离断术,发现副脾3例,并予以切除。三孔组5例门静脉高压性脾功能亢进患者加行腹腔镜胃底贲门周围血管离断术,发现副脾1例,并予以切除。单孔组手术时间略长于三孔组,差异有统计学意义(P<0.05);术后镇痛时间、术后排气时间及出院时间单孔组明显短于三孔组,差异有统计学意义(P<0.05);两组患者术中出血量差异无统计学意义(P>0.05)。术后患者均康复出院,随访2~13个月,无不适症状。结论:经脐单孔腹腔镜下二级脾蒂离断法行脾切除术由腹腔镜技术经验丰富的团队开展是安全、可行的,具有患者创伤小、术后疼痛轻、康复快等优点,手术切口微小,美观效果较好。

The clinical application of the transumbilical single-port iaparoscopic second splenic pedicle transection method in splenectomy

Objective：To investigate the valve of the transumbilical single-port laparoscopic second splenic pedicle transection method in splenectomy. Methods ： The clinical data of 30 patients who underwent transumbilical single-port laparoscopic splenectomy second splenic pedicle transection method from Jun. 2012 to Aug. 2013 were retrospectively analyzed. The patients were divided into sin- gle-port laparoscopic group and three-port laparoscopic group, and the intraoperative and postoperative conditions of the two groups were compared. Results：No severe postoperative complications occurred. In the single-port laparoscopic group,two patients were converted to single hand-assisted laparoscopy. 13 patients with portal hypertension and hypersplenism underwent laparoscopic pericardial devascular- ization, and 3 cases of accessory spleen were found and excised. In the three-port laparoscopic group ,5 patients with portal hypertension and hypersplenism underwent laparoscopic pericardial devaseularization, and one case of accessory spleen was found and excised. The operation time of single-port laparoscopie group was longer than the three-port laparoscopic group （ P 〈 0.05 ）. The postoperative analge- sia, exhaust time and discharge time was significantly shorter in the single-port laparoscopic group than the three-port laparoscopic group （ P 〈 0.05 ）. There was no significant difference between the 2 groups in the average amount of intraoperative bleeding （ P 〉 0.05 ）. These patients were aU discharged after surgery, no uncomfortable symptoms were found during the follow-up of 2 to 13 months. Conclusions：Based on rich experience of laparoscopy, the transumbilical single-port laparoseopic spleneetomy surgery second splenic pedicle transection method is safe and effective. The procedure is mini-invasive with less postoperative pain, faster recovery, smaller incision and better aesthetic effect.