中国普外基础与临床杂志

中国普外基础与临床杂志

全腹腔镜下“隧道法”原位脾切除术

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目的 探讨隧道法用于全腹腔镜下脾切除术的手术技巧及可行性。 方法 对重庆医科大学附属第二医院 2017 年 12 月收治的 1 例乙肝后肝硬变合并脾大、脾功能亢进患者资料进行总结。 结果 该患者在全腹腔镜下采用自下而上、从前往后、由浅入深的手术入路,充分暴露并显示胰腺尾部(脾蒂)上、下极,建立隧道后切除脾脏。手术时间 70 min,术中出血约 50 mL,术后第 5 天出院。 结论 隧道法用于全腹腔镜下脾切除术安全、有效。

Objective To discuss surgical skills and clinical value of laparoscopic splenectomy with behind splenic hilus tunnel-building technique. Method The clinical data of 1 patient with HBV-related hepatic cirrhosis combined splenomegaly and hypersplenism treated in the Second Affiliated Hospital of Chongqing Medical University was discussed and summarized. Results The patient underwent the laparoscopic splenectomy with surgical approach of from bottom to top, front to back, and shallow to deep. The key point of the tunnel-building technique was fully exposed the upper and lower poles of the splenic pedicle. The operative time was 70 min, the intraoperative blood loss was 50 mL, and the discharge time was 5 d after operation. Conclusion Laparoscopic splenectomy with behind splenic hilum tunnel-building technique is safe and feasible, especially for beginners.

关键词: 腹腔镜脾切除术; 隧道法

Key words: laparoscopic splenectomy; behind splenic hilum tunnel-building technique

引用本文: 李金政, 游科, 涂兵, 龚建平, 刘作金. 全腹腔镜下“隧道法”原位脾切除术. 中国普外基础与临床杂志, 2018, 25(3): 338-341. doi: 10.7507/1007-9424.201802062 复制

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1. 杨镇. 我国门静脉高压症外科治疗的现况和展望. 临床肝胆病杂志, 2016, 32(2): 250-253.
2. 杨镇, 万赤丹, 邓小荣. 腹腔镜门静脉高压症外科治疗发展与新断流术. 中华普外科手术学杂志 (电子版), 2017, 11(3): 181-184.
3. Delaitre B, Maignien B. [Splenectomy by the laparoscopic approach. Report of acase]. Presse Med, 1991, 20(44): 2263.
4. Misiakos EP, Bagias G, Liakakos T, et al. Laparoscopic splenectomy: Current concepts. World J Gastrointest Endosc, 2017, 9(9): 428-437.
5. Tada K, Ohta M, Saga K, et al. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia. Surg Today, 2018, 48(2): 180-185.
6. Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. In Vivo, 2017, 31(3): 291-302.
7. 展翰翔, 胡三元. 腹腔镜脾切除术的要点与难点. 腹腔镜外科杂志, 2016, (08): 567-569.
8. 别平, 陈健. 腹腔镜脾切除术. 中华肝脏外科手术学电子杂志, 2015, (3): 142-145.
9. Tsamalaidze L, Stauffer JA, Permenter SL, et al. Laparoscopic Splenectomy for Massive Splenomegaly: Does Size Matter? J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1009-1014.
10. 王广义, 蒋超. 腹腔镜脾切除技术演进与实践. 中华肝脏外科手术学电子杂志, 2017, 6(4): 241-244.
11. 陈罗飞. 腹腔镜下脾切除术及相关手术研究进展. 现代医药卫生, 2017, 33(10): 1487-1490.
12. 张焱辉, 蒋国庆, 唐俊, 等. 腹腔镜下巨脾切除加贲门周围血管离断术治疗肝硬化门静脉高压的疗效分析. 中华普外科手术学杂志 (电子版), 2017, 11(5): 414-416.
13. 刘新文. 腹腔镜下巨脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压 30 例. 中国现代普通外科进展, 2016, 19(4): 310-312.
14. 单志东, 牟一平, 杨瑾, 等. 门静脉高压症的腔镜外科治疗. 肝胆外科杂志, 2017, 25(5): 396-397.
15. 向俊西, 张安澎, 吕毅, 等. 腹腔镜脾切除术的技术发展及并发症的处理. 腹腔镜外科杂志, 2017, 22(8): 627-630.
16. 万赤丹, 唐勇. " 隧道法”腹腔镜脾切断流术. 中华普外科手术学杂志 (电子版), 2017, 11(3): 189.
17. 何成, 刘作金. 脾下极入路脾蒂控制法在全腔镜脾切除术中的应用. 局解手术学杂志, 2017, 26(5): 330-333.
18. 唐勇, 王文静, 张宇, 等. 腹腔镜脾切除加贲门周围血管离断术治疗门静脉高压症的疗效评价. 中华普通外科杂志, 2016, 31(2): 93-96.
19. Gonçalves D, Morais M, Costa-Pinho A, et al. Validation of a difficulty grading score in laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A. 2017 Oct 11. doi: 10.1089/lap.2017.0478. [Epub ahead of print].
20. 李涛, 杨镇. 精准医学时代门静脉高压症新断流术的进展. 临床外科杂志, 2017, 25(1): 30-31, 32.
21. Toro A, Vitale M, Livera D, et al. Is Laparoscopy Really Advantageous for Splenectomy Patients? World J Surg, 2018, 42(3): 902.
22. Sakamoto K, Honda G, Kurata M, et al. Safe approach to the splenic hilum by first mobilizing the pancreatic tail in laparoscopic splenectomy. Asian J Endosc Surg, 2017, 10(1): 83-86.
23. Somasundaram SK, Massey L, Gooch D, et al. Laparoscopic splenectomy is emerging ‘gold standard’ treatment even for massive spleens. Ann R Coll Surg Engl. 2015 Jul 9: 1-4. [Epub ahead of print].
24. 许桐林, 邱烽, 蔡卫华. 早期应用低分子肝素加阿司匹林预防肝硬化脾脏切除术后门静脉血栓形成. 南京医科大学学报 (自然科学版), 2017, (12): 1644-1645.
25. Jiang GQ, Bai DS, Chen P, et al. Risk Factors for Portal Vein System Thrombosis After Laparoscopic Splenectomy in Cirrhotic Patients with Hypersplenism. J Laparoendosc Adv Surg Tech A, 2016, 26(6): 419-423.
26. Qian YY, Li K. The early prevention and treatment of PVST after laparoscopic splenectomy: A prospective cohort study of 130 patients. Int J Surg, 2017, 44: 147-151.