腹腔镜脾切除术65例临床研究

目的探讨腹腔镜脾切除术的手术技巧、影响因素及效果。方法回顾性分析本院2003年8月至2008年9月65例腹腔镜脾切除术的临床资料。结果65例中63例顺利完成腹腔镜脾切除术，2例腹腔镜脾切除取出脾脏后脾窝渗血中转小切口开腹脾窝止血，腹腔镜手术成功率达96．9％。手术时间50～180min，平均90min。术中出血量10～600ml，平均60ml。术中切除副脾14个，同时行胆囊切除3例，肝活检术4例。全组术后6～12h拔除胃管、尿管并下床活动，12～24h恢复进食。无并发症发生，无手术死亡，平均住院时间6．2d。结论只要熟练掌握腹腔镜技巧，腹腔镜脾切除术是一种安全可行的微创手术方式，值得临床推广。术中体位的选择，脾周韧带的分离，脾蒂的处理是手术成功的关键因素。

Laparoscopic splenectomy: Report of 65 cases

Objective To explore the surgical techniques, influence factors and effects of Laparoscopic splenectomy （LS）. Methods The clinical data of 65 patients who had undergone LS between August 2003 and September 2008 were analyzed retrospectively. Results LS was successfully done in 63 patients （96.9%） , whereas a conversion to open surgery（ hemostasis of splenic recess via mini-incision ） was required in 2 patients because of oozing of blood in the splenic recess after spleens were taken out. The operation time ranged from 50 to 180 minutes （average 90 minutes）. Operative blood loss ranged from 10 to 600 ml （average 60 ml）. Among the 65 patients, accessory splenectomy was performed in 14, laparoscopie cholecystectomy was performed in 3, and liver biopsy was performed in 4. In the entire group, gastric tube and urinary catheter were removed and proper off-bed activities were done 6 - 12 hours after the operation; food taking resumed 12 -24 hours after the operation. No complication and mortality were observed. The mean postoperative hospitalization was 6.2 days. Conclusions LS is a kind of safe and minimally invasive surgery and worthy to be further popularized when laparoscopy operation is skillfully mastered. The proper selection of operative position, satisfactory exposure and dissection of peri-splenic ligaments and constitution, and successful control of the splenic pedicel are the key points to a successful operation.