采用圈套器套扎脾蒂的腹腔镜脾切除术治疗外伤性脾破裂63例

目的探讨外伤性脾破裂行腹腔镜脾切除术(LS)的安全性和可行性。方法回顾性分析我院2009年3月至2017年8月63例外伤性脾破裂行LS术临床资料,术中采用先结扎脾动脉,再用圈套器套扎脾蒂切除脾脏48例,采用二级脾蒂离断法逐根结扎切断进入脾脏血管切除脾脏15例。结果 60例顺利完成LS术,3例因脾脏出血或粘连严重中转开放手术,手术时间60~170 min,平均120 min,术中出血量100~800 m L,平均400 m L。术后无大出血、胰漏、血栓形成等并发症发生。结论外伤性脾破裂行LS术采用先结扎脾动脉,再用圈套器套扎脾蒂切除脾脏或二级脾蒂离断法逐根结扎切断进入脾脏血管切除脾脏是安全和可行的,效果满意,创伤小,恢复快,住院时间短。

Clinical analysis of 63 cases undergoing laparoscopic splenectomy for splenic traumatic rupture by the ligation of splenic pedicle by snare

Objective To investigate the safety and feasibility of laparoscopic splenectomy（LS）for splenic traumatic rupture. Methods The clinical data of 63 cases with splenic traumatic rupture from March 2009 to August 2017 were analyzed retrospectively. Forty-eight cases underwent splenic artery ligation followed by the ligation of splenic pedicle by snare, 15 cases underwent secondary splenic pedicle dissection. Results Sixty cases underwent successfully LS, 3 cases required the conversion to laparotomy due to the splenic bleeding or the serious adhesion. The operative time was 60- 170 min with a mean time of 120 min, whilst the mean volume of blood loss was 100-800 ml with a mean volume of 400 ml. No complication such as hemorrhea, pancreatic fistula or thrombosis occurred following LS. Conclusion Splenic artery ligation followed by the ligation of splenic pedicle by snare or secondary splenic pedicle dissection in LS for splenic traumatic rupture is safe and feasible with the satisfactory effect, the minimal invasion, the rapid recovery, the short hospitalizing time, which is worth spreading in clinically.