依从体位改变实现联合入路在程序化腹腔镜脾切除术中的应用
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摘要
目的总结依从体位改变实现联合入路用于程序化腹腔镜脾切除术(LS)的效果和经验。方法回顾性分析2014年7月至2017年6月安徽医科大学附属安庆医院普外科行LS共47例患者的临床资料,手术采用两次调床,依从体位改变实现联合入路,完成程序化的三步主要操作。结果 46例患者在全腔镜下顺利完成手术,1例行辅助小切口手助完成手术。手术时间(91.49±11.96)min,术中出血(279.89±102.44)mL,未发生不可控制的大出血。术后胃肠道恢复通气时间(2.13±0.21)d,拔除引流管时间(4.77±1.52)d,术后未出现胰漏和腹腔内出血等并发症,反应性胸腔积液7例,术后住院时间(7.79±1.28)d。术后随访1～35个月,随访期间无死亡病例。结论依从体位改变实现联合入路行程序化LS成功率高,术后并发症发生率低,患者术后恢复快,易于基层医院学习掌握,值得临床推广。
Objective To summarize the experience of combined approaches to laparoscopic splenectomy(LS) following a standardized technique by operative position changes. Methods The clinical data of 47 patients who underwent LS in Anqing Hospital from Jul. 2014 to Jun. 2017, were retrospectively analyzed. The LS was performed by adjusting the patients' operative position twice, thus realizing a combined approach, as well as by using a standardized 3-step technique. Results Forty-six patients performed LS successfully, with only one patient having an additional small incision to complete the operation. Operation duration was(91.49±11.96) min. Intraoperative bleeding was(279.89±102.44) mL and no uncontrollable bleeding was found. The postoperative time of anus aerofluxus was(2.13±0.21) d. The duration of postoperative indwelling drainage catheter was(4.77±1.52) d. No pancreatic leakage or intra-abdominal hemorrhage was found, and only reactive pleural effusion was reported in 7 cases. Postoperative hospitalization length was(7.79±1.28) d. No death was found in all patients during follow-up(1 to 35 months). Conclusion The combined approach for programmed LS has high success rate, low incidence of postsurgical complications, and short recovery time. It is a convenient and effective procedure that can be further expanded, especially in basic-level hospital.
Objective To summarize the experience of combined approaches to laparoscopic splenectomy(LS) following a standardized technique by operative position changes. Methods The clinical data of 47 patients who underwent LS in Anqing Hospital from Jul. 2014 to Jun. 2017, were retrospectively analyzed. The LS was performed by adjusting the patients' operative position twice, thus realizing a combined approach, as well as by using a standardized 3-step technique. Results Forty-six patients performed LS successfully, with only one patient having an additional small incision to complete the operation. Operation duration was(91.49±11.96) min. Intraoperative bleeding was(279.89±102.44) mL and no uncontrollable bleeding was found. The postoperative time of anus aerofluxus was(2.13±0.21) d. The duration of postoperative indwelling drainage catheter was(4.77±1.52) d. No pancreatic leakage or intra-abdominal hemorrhage was found, and only reactive pleural effusion was reported in 7 cases. Postoperative hospitalization length was(7.79±1.28) d. No death was found in all patients during follow-up(1 to 35 months). Conclusion The combined approach for programmed LS has high success rate, low incidence of postsurgical complications, and short recovery time. It is a convenient and effective procedure that can be further expanded, especially in basic-level hospital.
引文
[1]凌新建,昝建宝,余宏铸.腹腔镜与开腹脾切除术在治疗肝硬化所致脾功能亢进中的对比研究[J].中国现代医学杂志,2016,26(22):54-58.
[2]周进学,展翔宇,李庆军,等.二级脾蒂离断在腹腔镜脾切除术中的应用[J].中华普通外科杂志,2017,32(2):119-121.
[3]李永利,王涛,朱立峰.腹腔镜脾切除术治疗难治性免疫性血小板减少症疗效观察[J].肝胆胰外科杂志,2015,27(3):187-189.
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[9]蒋国庆,钱建军,陈平,等.改良的完全腹腔镜下脾切除加贲门周围血管离断术手术经验[J].肝胆胰外科杂志,2013,25(6):444-447.
[10]胡仁建,秦红军,程刚,等.腹腔镜下脾切除术的几点探讨[J].肝胆胰外科杂志,2015,27(2):143-145.
[11]麻勇,姜洪池.部分脾切除的有关技术[J].中华肝胆外科杂志,2009,15(3):233-236.
[12]施申超,唐勇,张宇,等.经脾蒂上缘间隙行腹腔镜脾切除术的临床疗效[J].中华消化外科杂志,2017,16(5):508-513.
[13]王明,蔡龙,郑晓凤,等.腹腔镜脾切除术39例临床分析[J].肝胆胰外科杂志,2013,25(5):404-406.
[14]Michels NA.The variational anatomy of the spleen and splenic artery[J].Am J Anat,1942,70(1):21-72.
[15]李飞波,赵伏义,董朝富.腹腔镜二级脾蒂离断法脾切除术治疗外伤性脾破裂体会[J].肝胆胰外科杂志,2013,25(2):143-144.
[16]唐才喜,陈迅.腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症34例体会[J].肝胆胰外科杂志,2015,27(6):512-514.
[17]刘斌,陈肖鸣,林孝坤,等.不同脾蒂离断法在腹腔镜脾切除治疗ITP中的成本-效果比较[J].肝胆胰外科杂志,2011(1):31-34.
[18]洪德飞.腹腔镜脾脏切除的手术操作技巧[J].肝胆外科杂志,2010,18(6):406-408.
[19]Park AE,Birgisson G,Mastrangelo MJ,et al.Laparoscopic splenectomy:outcomes and lessons learned from over 200cases[J].Surgery,2000,128(4):660-667.
[2]周进学,展翔宇,李庆军,等.二级脾蒂离断在腹腔镜脾切除术中的应用[J].中华普通外科杂志,2017,32(2):119-121.
[3]李永利,王涛,朱立峰.腹腔镜脾切除术治疗难治性免疫性血小板减少症疗效观察[J].肝胆胰外科杂志,2015,27(3):187-189.
[4]徐鹏,孙鸣,刘凤先,等.术前256层螺旋CT显示脾叶动脉与脾段动脉[J].中国医学影像技术,2012,28(11):2033-2036.
[5]Han ES,You YK,Kim DG,et al.Clinical signifi cance of singleport laparoscopic splenectomy:comparison of single-port and multiport laparoscopic procedure[J].Ann Surg Treat Res,2015,89(2):55-60.
[6]Machado MA,Makdissi FF,Herrmn P,et al.Exposure of splenic hilum increases safety of laparoscopic splenectomy[J].Surg Laparosc Endosc Percutan Tech,2004,14(1):23-25.
[7]胡三元,陈波,王可新,等.后外侧入路腹腔镜脾切除术:附37例报告[J].中华肝胆外科杂志,2007,13(5):309-310.
[8]鲍胜华,孙卫东,胡明华,等.前入路分层解剖腹腔镜原位脾切除的临床应用[J].中华肝胆外科杂志,2011,17(4):289-291.
[9]蒋国庆,钱建军,陈平,等.改良的完全腹腔镜下脾切除加贲门周围血管离断术手术经验[J].肝胆胰外科杂志,2013,25(6):444-447.
[10]胡仁建,秦红军,程刚,等.腹腔镜下脾切除术的几点探讨[J].肝胆胰外科杂志,2015,27(2):143-145.
[11]麻勇,姜洪池.部分脾切除的有关技术[J].中华肝胆外科杂志,2009,15(3):233-236.
[12]施申超,唐勇,张宇,等.经脾蒂上缘间隙行腹腔镜脾切除术的临床疗效[J].中华消化外科杂志,2017,16(5):508-513.
[13]王明,蔡龙,郑晓凤,等.腹腔镜脾切除术39例临床分析[J].肝胆胰外科杂志,2013,25(5):404-406.
[14]Michels NA.The variational anatomy of the spleen and splenic artery[J].Am J Anat,1942,70(1):21-72.
[15]李飞波,赵伏义,董朝富.腹腔镜二级脾蒂离断法脾切除术治疗外伤性脾破裂体会[J].肝胆胰外科杂志,2013,25(2):143-144.
[16]唐才喜,陈迅.腹腔镜下脾切除联合贲门周围血管离断术治疗门静脉高压症34例体会[J].肝胆胰外科杂志,2015,27(6):512-514.
[17]刘斌,陈肖鸣,林孝坤,等.不同脾蒂离断法在腹腔镜脾切除治疗ITP中的成本-效果比较[J].肝胆胰外科杂志,2011(1):31-34.
[18]洪德飞.腹腔镜脾脏切除的手术操作技巧[J].肝胆外科杂志,2010,18(6):406-408.
[19]Park AE,Birgisson G,Mastrangelo MJ,et al.Laparoscopic splenectomy:outcomes and lessons learned from over 200cases[J].Surgery,2000,128(4):660-667.