[1]许景洪①,卢榜裕*,蔡小勇,等.腹腔镜下脾切除脾血管的解剖基础及临床应用[J].中国微创外科杂志,2008,08(1):26-28.
　Xu Jinghong,Lu Bangyu*,Cai Xiaoyong*,et al.Anatomical Basis and Clinical Application of Laparoscopic Splenectomy[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):26-28.
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腹腔镜下脾切除脾血管的解剖基础及临床应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
26-28
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Anatomical Basis and Clinical Application of Laparoscopic Splenectomy
作者:
许景洪①; 卢榜裕*; 蔡小勇; 陆文奇; 黄裕斌; 黄飞
广西医科大学第一附属医院微创外科，南宁530007
Author(s):
Xu Jinghong;  Lu Bangyu*;  Cai Xiaoyong*;  et al.
*Department of Minimally Invasive Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530007, China
关键词:
外科学; 腹腔镜; 脾切除术; 解剖学
Keywords:
Surgery; Laparoscopy; Splenectomy; Anatomy
分类号:
R657.6
文献标志码:
A
摘要:
目的探讨腹腔镜下脾血管解剖的特点及临床应用价值。方法分析完全腹腔镜脾切除术（TLS）47例资料。其中肝硬化门静脉高压症21例，地中海贫血19例，原发性血小板减少性紫癜2例，球形红细胞增多症2例，脾血管瘤1例，脾囊肿1例，原发性脾功能亢进1例。根据胰尾段内结扎脾动脉后，脾脏呈现颜色改变，总结脾血管腔镜下解剖分型。结果脾血管为Ⅰ型(分支型)者占72.3%(34/47)；Ⅱ型(主干型)占19.1%(9/47)；Ⅲ型(迷走型)占4.3%(2/47)；腔镜下解剖不清2例(43%)。46例成功完成TLS，手术成功率97.9%(46/47)，14例同时行腹腔镜下贲门周围血管离断术，3例地中海贫血因胆囊结石同时行腹腔镜下胆囊切除术；1例因凝血功能障碍术中广泛创面渗血而中转开腹行创面止血。43例经脾动脉结扎,45例经脾门血管分级离断技术得以完成手术。TLS手术时间50～240 min，(110±35) min。出血量20~1500 ml,(160±87) ml。结论腹腔镜下脾血管绝大部分以分支型为主，但可以在胰尾上缘结扎脾动脉阻断脾脏的大部分血供，脾门血管可以进行分级离断。脾动脉结扎、脾门血管分级离断是控制术中出血、防止胰腺损伤的有效技术。
Abstract:
ObjectiveTo investigate the laparoscopic anatomy of the spleen vessels and its clinical application.Methods The data of 47 cases of total laparoscopic splenectomy (TLS) were analyzed. Among the patients, 21 had cirrhotic portal hypertension, 19 had thalassemia, 2 idiopathic thrombocytopenic purpura, 2 hereditary spherocytosis, 1 angioma of the spleen, 1 splenic cyst, and 1 primary hypersplenism. The color of the spleen was observed after the splenic artery near the pancreatic tail was ligated. And then the splenic artery was categorized according to the color.ResultsAmong the 47 cases, 34 (72.3%) were categorized as typeⅠ, 9 were type Ⅱ (19.1%), and 2 were type Ⅲ (4.3%). The arterial anatomy was unclear under a laparoscope in 2 cases (4.3%). The TLS was completed in 46 cases with a success rate of 97.9% (46/47). Among the cases, 14 received extensive esophagogastric devascularization simultaneously，and 3 patients who had thalassemia underwent cholecystecotomy after the TLS because of gallbladder stones. One case was converted to an open surgery because of extensive bleeding owning to coagulation disorder. The spleen artery was ligated in 43 cases, and the hilar vessels were resected by dissecting and ligating in 45 cases. The Operation time averaged at (110±35) min (range 50-240 min), and the mean intraoperative blood loss was (160±87) ml (range, 20-1500 ml). ConclusionsIn spite of the prominent type Ⅱ of the spleen vessels, the spleen artery can be dissected and ligated at the level of the superior edge of the pancreatic tail to stop the blood supply to the spleen. The hilar vessels can be resected by dissecting and ligating. The spleen artery ligation and hilar vessels resection by dissecting and ligating are effective in controlling intraoperative bleeding and avoiding pancreas injury.

参考文献/References:

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备注/Memo

备注/Memo:
①（广西民族医院普通外科，南宁530001）*通讯作者
更新日期/Last Update: 2013-10-22