Thibault C, Mamazza J, Létourneau R, Poulin E
Department of Surgery, Hôpital du Saint-Sacrement, Université Laval, Québec, Chemin Ste-Foy, Canada.
Surg Laparosc Endosc. 1992 Sep;2(3):248-53.
A technique of laparoscopic splenectomy was developed on animal models and subsequently applied in two human patients. After creation of a 15 mm Hg pneumoperitoneum, five trocars, two with 12-mm diameters, were introduced into the upper abdomen. The spleen was approached directly by dissection of the gastrosplenic ligament. The short gastric vessels and hilar vessels were individually ligated with metallic clips or a surgical stapler, depending on their size. A plastic bag was then introduced into the abdominal cavity and the spleen slipped inside. An umbilical incision measuring 2 to 3 cm was used for extraction after finger fracture of the spleen. After laboratory experience with seven animals, we used this operation on two patients. The first procedure had to be converted to open surgery because of hemorrhage; the second was successfully performed within 4 h. Knowledge of anatomic variations and meticulous surgical technique are necessary for the successful completion of splenic laparoscopic surgery.
一种腹腔镜脾切除术技术在动物模型上得以研发，随后应用于两名人类患者。建立15毫米汞柱的气腹后，将五根套管针，两根直径为12毫米的，插入上腹部。通过解剖胃脾韧带直接显露脾脏。根据胃短血管和脾门血管的大小，分别用金属夹或外科吻合器进行结扎。然后将一个塑料袋放入腹腔，脾脏滑入其中。脾脏经手指捏碎后，通过一个2至3厘米的脐部切口取出。在对七只动物进行实验后，我们对两名患者实施了该手术。第一例手术因出血不得不转为开放手术；第二例手术在4小时内成功完成。了解解剖变异并掌握精细的手术技巧是成功完成腹腔镜脾切除术的必要条件。
