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50～240min,(110±35)min。出血量20～1500ml,(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。
Objective To 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 th...
出处
《中国微创外科杂志》
CSCD
2008年第1期26-28,共3页
Chinese Journal of Minimally Invasive Surgery
