腹腔镜脾切除术脾蒂处理影响因素及对策
马富平 安东均 晁延军 董浩 张成
摘 要
目的：探讨腹腔镜脾切除术脾蒂处理的影响因素及对策。
方法：右侧斜卧位、超声刀、ligasure，二级脾蒂处理，手助。
结果：39例中2例因为脾脏明显肿大，直接行腹腔镜下手助脾脏切除；1例因术中脾静脉出血转手助操作完成手术；余36例行完全腹腔镜下脾脏切除术，其中采用超声刀分离，二级脾蒂处理方法30例；Ligasure分离脾蒂血管、断离3例，超声刀分离、Endo-GIA夹闭2例，无中转开腹术，无死亡病例，手术后有1例并发少量胰漏，引流3周后痊愈。
结论：结合脾蒂解剖的特点，采取适当体位及处理方法，可安全完成腹腔镜脾切除术。
关键词
腹腔镜脾切除术；脾蒂
ABSTRACT
Objective:To explore influtial factor and Strategy in handling splenic pedicle in laparoscopic splenectomy.
Methods:right arm recumbent，ultrasound knife、ligasure、second order splenic pedicle handling.
Results:Two of the 39 cases were converted to hand-assisted splenectomy due to splenomegaly；one case was converted to hand-assisted technique intraoperatively due to massive bleeding，and the other 36 patients underwent the operation with laparoscopy.None was converted to open laparotomy.No mortality occurred.Only one patient was complicated with pancreatic leakage.which stopped 3 weeks later with the help of continuous drainage.
Conclusion:LS is safe and feasible by adopt proper position and method according to anatomical characteristic of Splenic pedicle.
KEY WORDS
Laparoscopy Splenectomy；Splenic pedicle
自1991年Delaitre等［1］报道首例腹腔镜脾切除术以来，腹腔镜脾切除术已成为治疗多种疾病所致脾脏疾病的标准术式，其中脾蒂的安全处理是决定腹腔镜脾切除术成败的关键因素，收集自2001年7月至今已施行腹腔镜脾切除术39例，报道如下。