Tagaya Nobumi, Rokkaku Kyu, Kubota Keiichi
Second Department of Surgery, Dokkyo University School of Medicine, Tochigi, Japan.
J Laparoendosc Adv Surg Tech A. 2002 Jun;12(3):213-6. doi: 10.1089/10926420260188137.
Needlescopic instruments are being used in various fields of endoscopic surgery. We evaluated the safety and efficacy of laparoscopic splenectomy using a needlescope.
This procedure was performed in three patients, two women and one man, having idiopathic thrombocytopenic purpura that had not responded to medical treatment. Four ports (one 12 mm and three 2 mm in diameter) were introduced into the left upper quadrant. A 2-mm needlescope was used throughout the procedure. The spleen was divided from the splenocolic, splenophrenic, and splenorenal ligaments posterior to the splenic hilum. The splenic hilar and short gastric vessels were divided simultaneously using a linear stapler. The resected spleen was morcellated via the 12-mm port.
The mean operation time was 167 minutes, and the mean estimated blood loss was 70 mL. No postoperative analgesia was needed by any of the patients, and there were no perioperative complications. The 2-mm postoperative scars were virtually invisible.
Needlescopic splenectomy for idiopathic thrombocytopenic purpura is feasible and safe with less postoperative pain and a superior cosmetic result compared with conventional laparoscopic splenectomy.
针状内镜器械正应用于内镜手术的各个领域。我们评估了使用针状内镜进行腹腔镜脾切除术的安全性和有效性。
对3例患者实施了该手术，其中2例女性，1例男性，均患有药物治疗无效的特发性血小板减少性紫癜。在左上腹置入4个端口（1个直径12mm，3个直径2mm）。整个手术过程使用2mm针状内镜。在脾门后方从脾结肠韧带、脾肾韧带和脾膈韧带游离脾脏。使用线性切割吻合器同时离断脾门血管和胃短血管。经12mm端口将切除的脾脏切碎取出。
平均手术时间为167分钟，平均估计失血量为70ml。所有患者术后均无需镇痛，且无围手术期并发症。2mm的术后瘢痕几乎不可见。
与传统腹腔镜脾切除术相比，针状内镜脾切除术治疗特发性血小板减少性紫癜是可行且安全的，术后疼痛较轻，美容效果更佳。
