应用脾蒂先离断技术行手助腹腔镜巨脾切除与断流术

目的探讨手助腹腔镜巨脾切除术中脾门先离断技术的可行性。方法2003年8月-2009年12月，用脾门先离断技术完成手助腹腔镜巨脾切除16例，其中14例同时行贲门周围血管离断术。离断胃结肠韧带后，用伸人腹腔的手指分离脾蒂与其外侧腹膜之间的疏松组织，穿过脾蒂下方后，在手指引导下于脾蒂后方穿过吻合器钉座，击发后离断脾蒂。然后再离断脾周围韧带，完整切除脾脏。结果所有手术均顺利完成。手术时间（152．0±39．9）rain，术中出血量（263．8±161．2）ml，3例需要术中输血。无术后出血、膈下感染、发热等并发症。所有病例均获电话随访，随访时间1-40个月，平均24个月。无术后远期并发症，血小板计数1个月内恢复正常，随访期间无食管静脉曲张破裂再出血。结论脾蒂先离断技术可以增加手术安全性，缩短手术时间，减少术后并发症发生机会。

Hand-assisted Laparoscopic Splenectomy and Devascularization for Portal Hypertension: Hilum-First Approach

Objective Laparoscopic splenectomy for splenomegaly is still a great challenge technically. Herein we introduce a hilum first approach in hand-assisted laparoscopic splenectomy for patients with splenomegaly. Methods From August 2003 to December 2009, we performed hand assisted laparoscopic splenectomy in 16 patients with splenomegaly caused by portal hypertension; peri-esophagus devascularization was performed on 14 of the cases at the same time. The loose space between splenic hilum and renal- splenic ligament was dissected with the fingers, through which a stapler was introduced and the hilum was transected before dissociating the spleen. Results All the procedures were completed successfully without conversion to conventional surgery. The mean operative time was （ 152.0±39.9） min （ range 85 - 240 min） and the blood loss was （263.8±161.2） ml （ range 50-600 ml）. Intraoperative blood infusion was necessary in 3 cases. All the patients recovered smoothly without severe perioperative complications （ postoperative hemorrhage, infection, fever, etc. ）. A mean of 24 months （1 -40 months） follow up was achieved in all the cases by telephone. No long term complications were observed in the patients. During the follow-up period, all the patients recovered with normal platelet count in one month. No patient had hemorrhage caused by rupture of esophageal variees. Conclusions Hilum first approach may effectively decrease operation time and rate of postoperative complication, and increase surgical safety.