Tan Min, Zheng Chao-Xu, Wu Zhi-Mian, Chen Guo-Tai, Chen Liu-Hua, Zhao Zhen-Xian
Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
World J Gastroenterol. 2003 May;9(5):1086-9. doi: 10.3748/wjg.v9.i5.1086.
To introduce our latest innovation on technical manipulation of laparoscopic splenectomy.
Under general anesthesia and carbon dioxide (CO(2)) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48 cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with Endo-GIA. The impact of different operative positions, spleen size and other events during the operation were studied.
The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS.
Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.
介绍我们在腹腔镜脾切除术技术操作方面的最新创新。
在全身麻醉和二氧化碳（CO₂）气腹下，进行了86例腹腔镜脾切除术（LS）。患者被置于三种不同的手术体位：7例截石位，31例右侧卧位，48例右侧卧位。使用超声刀分别解剖胰脾韧带、脾结肠韧带、脾肾韧带和脾膈韧带。最后，解剖胃脾韧带和胃短血管。在脾门处用Endo-GIA切除脾动脉和脾静脉。研究了不同手术体位、脾脏大小及手术过程中的其他情况的影响。
1997年8月至2002年8月，所有86例患者的腹腔镜脾切除术均成功完成。未观察到手术并发症，如腹腔感染、术后大出血及邻近器官损伤。无手术相关死亡。研究表明，不同手术体位可显著影响腹腔镜脾切除术的操作。在腹腔镜脾切除术中，右侧卧位比截石位和右侧卧位更具优势。
大多数腹腔镜脾切除术病例在患者处于右侧卧位时可成功完成。右侧卧位比传统仰卧位更具优势，能更直接地观察脾门及其他重要解剖结构。无论手术体位如何，体外B超显示脾脏长径超过15 cm肯定会增加腹腔镜脾切除术的难度，从而延长手术时间。腹腔镜脾切除术是一种安全可行的脾切除方式。
