手术体位对腹腔镜脾切除术操作的影响

目的探讨不同的手术体位在腹腔镜脾切除术时对操作的影响.方法利用腹腔镜对43例病人进行脾切除术,并对术中出现的情况、手术体位与脾脏的大小、解剖关系及手术难易程度等进行总结性分析.结果43例病人无术中及术后并发症出现.不论何种体位,体外B超脾脏长径＞15cm者手术难度明显增加,手术时间延长.结论大多数腹腔镜脾切除术可以采用右斜卧位完成,对于长径＞15cm的脾脏,采用右侧卧位可能更为有利.腹腔镜脾切除术是脾脏手术的最佳方法之一.

Effects of different position on laparoscopic splenectomy.

Objective The report aimed to investigate the effect of the different operative position on laparoscopic splenectomy(LS).Methods Under general anesthesia and carbon dioxide(CO 2) pneumoperitoneum,43 cases of LS were performed with lithotomic position,right oblique and right side clinostatism position respectively.The relationship between different position in operative and the size,the anatomic structure of spleen,the events during the operation and the difficulty of performance were studied.Results All the cases were undertaken uneventfully.In regardless of the position,the difficulty of the operation would be increased and the operation would be prolonged if the diameter of the spleens exceeded 15cm measured by B ultrasound in vitro.Conclusion Conclusions LS in most of the cases could be accomplished at right side oblique position.For the giant spleens,over 15cm in axial diameter,right side clinostatism position would be favorable to performance.In general laparoscopic splenectomy might be one of the most reliable approaches if the surgeon was familiar with the surgical indications,laparoscopic technique and the alternatives of favorable position.