摘要
目的探讨二级脾蒂离断法在腹腔镜脾切除术（laparoscopic splenectomy，LS）的应用价值及临床疗效。方法2000年7月～2005年12月对特发性血小板减少性紫癜（idiopathic thrombocytopenia purpura，ITP）21例，脾囊肿1例，采用4孔法，无损伤钳靠近脾脏夹住脾结肠韧带并抬起脾脏，分离、切断脾周韧带。无损伤钳在距脾门3～5cm处钳夹脾蒂，以控制术中出血。超声刀切开脾蒂浆膜，自下而上沿脾脏逐支分离脾动、静脉的二级分支，Hem-o-lok结扎夹结扎2道，在两结扎夹之间用超声刀离断，切除脾脏。自扩大的trocar切口在自制的标本袋内搅碎脾脏并取出。结果22例均完成LS，手术时间75～180min，平均117min；术中出血量20～280ml，平均87ml。术后1～2d恢复饮食并下地活动。术后住院5～11d，平均5．6d。1例切口皮下血肿，1例皮下气肿。22例随访1．5～52个月，平均19．3月，无并发症。结论二级脾蒂离断法行LS，安全可靠，无须切割闭合器，手术费用降低。
Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoseopie spleneetomy （LS）. Methods Twenty-one cases of idiopathic thrombocytopenic purpura （ITP） and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy. After the spleen was mobilized, a non-traumatic forceps was used to clip the pedicel at the site 3～5 cm from the hilus of spleen for the control of hemorrhage. The serosa on the spleen pedicel was opened by using a harmonic scalpel. Then secondary structures of the splenic arteries and veins, one by one, were disconnected from without upward, double ligated with the Hem-o-lok clips, and severed with the harmonic scalpel. The spleen was placed into an extraction bag, broken into small pieces, and removed from the extraction incision. Results The laparoscopic splenectomy was successfully completed in all the 22 cases. The operative time was 75～180 min （mean, 117 min）, and the estimated intraoperative blood loss was 20～280 ml （mean, 87 ml）. All the patients got out of bed and began to take food at 1～2 days after operation. The length of postoperative hospitalization was 5～11 d （mean, 5.6 d）. There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema. Follow-up for 1.5～52 months （mean, 19.3 months） in the 22 cases revealed no surgery-related complications. Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoseopie spleneetomy.
出处
《中国微创外科杂志》
CSCD
2006年第9期691-692,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
脾切除术
脾蒂
Laparoseopy
Splenectomy
Spleen pedicel
