【摘要】 目的探讨腹腔镜手术治疗脾良性病变的临床效果。方法 2007年6月~2014年6月,我科采用腹腔镜手术治疗19例脾良性病变,其中12例行腹腔镜脾切除,4例脾囊肿行囊肿开窗术,2例脾囊肿行脾下极部分切除,1例局限于脾上极的脾淋巴管瘤应用Habib 4X行腹腔镜脾上极切除术。结果 19例均在腹腔镜下完成,无中转开腹。12例行脾切除术,其中一级脾蒂法5例,手术时间60~115 min(平均85 min),术中出血30~300 ml(平均170 ml);二级脾蒂法7例,手术时间85~195 min(平均105 min),术中出血30~500 ml(平均240 ml)。4例脾囊肿行囊肿开窗术,手术时间55~70 min(平均60min),术中出血20~50 ml(平均30 ml)。3例行脾部分切除术,手术时间分别为90、110、110 min,术中出血分别为40、60、100ml。1例由于术后短时间引流量多、引流液色红而再次行腹腔镜探查,发现取脾时意外撕裂大网膜导致出血,成功在腹腔镜下止血。术后住院4~11 d,平均6.0 d,无术后并发症。19例随访3~87个月,中位随访时间35个月,12例脾切除术无远期并发症发生,6例脾囊肿行开窗术或脾部分切除术未见囊肿复发,1例脾淋巴管瘤行脾上极切除术后无肿瘤残留、复发。结论腹腔镜脾切除及部分切除术治疗脾良性病变疗效满意。更多还原

【Abstract】 Objective To investigate the clinical effects of laparoscopic surgery in the treatment of splenic benign lesions.Methods From June 2007 to June 2014,19 patients with splenic benign lesions were given laparoscopic surgery in our department.There were 12 cases of laparoscopic splenectomy,4 cases of splenic cyst fenestration,2 cases of partial resection of the lower spleen for splenic cysts,and 1 case of resection of lower pole of the spleen with Habib 4X for splenic lymphangioma confined in the upper pole of spleen. Results The laparoscopic surgery was successfully performed in all the patients. Among 12 cases of laparoscopic splenectomy,primary splenic pedicle procedure was used in 5 cases with an operation time of 60- 115 min( mean,85 min) and an intraoperative blood loss of 30- 300 ml( mean,170 ml),and secondary splenic pedicle procedure was used in 7 cases with an operation time of 85- 195 min( mean,105 min) and an intraoperative blood loss of 30- 500 ml( mean,240 ml). In the 4 cases of fenestration,the operative time was 55- 70 min( mean,60 min) and the intraoperative blood loss was 20- 50 ml( mean,30 ml). In3 cases of partial splenectomy,the operation time was 90 min,110 min,and 110 min,respectively,and the intraoperative blood loss was 40 ml,60 ml,and 100 ml,respectively. One patient underwent laparoscopic re-exploration due to postoperative large volume red drainage in short time. During the exploration,accidental laceration of the greater omentum leading to bleeding was encountered,and the bleeding was stopped under laparoscopy successfully. The mean postoperative hospital stay was 6. 0 d( range,4- 11 d). No operative complications were observed. The patients were followed up for 3- 87 months with a mean of 35 months,during which 12 cases of laparoscopic splenectomy had no long-term complications,6 cases of splenic cyst fenestration or partial splenectomy showed no recurrence,and the case of splenic lymphangioma had no residual or recurrence. Conclusion Laparoscopic splenectomy and partial splenectomy are safe,minimally invasive,and feasible for patients with splenic benign lesions.更多还原