Wang Guang-yi, Liu Ya-hui, Lü Guo-yue, Liu Kai, Zhang Wei, Li Nan, Tan Yu-quan
Department of General Surgery, First Hospital of Jilin University, Changchun 130021, China.
Zhonghua Wai Ke Za Zhi. 2008 Oct 1;46(19):1457-9.
To evaluate the safety and utility of the methods of spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy.
The methods and the curative effect of 32 patients with laparoscopic splenectomy performed by the way as mentioned above were summarized and analyzed. 4 males, 28 females, median 36 years (range 16 - 64 years). Mean dimensions of spleens were 17 cm (range 11 - 23 cm). Nineteen patients had idiopathic thrombocytopenia purpura (ITP), 6 hereditary spherocytosis (HS) (5 of them were the same family constellation), 3 hemolytic anemia (HA), 2 spleen injury with haematoma infection, 1 Evan syndrome, 1 leukemia. Peri-splenic ligaments were resected by LigaSure combined with ultrasound scalpel, splenic pedicle was resected by spleen sub-pedicle two steps severance with LigaSure when splenic pedicle were sufficiently free. Splenic pedicle was non-excisional occluded by LigaSure at pancreatic cauda, in the first step and was occluded and resected alongside of the spleen in the second step.
All of the 32 cases were completely succeed, the average operating time was 70 min (55 - 130 min), the estimated intraoperative blood loss was 200 ml (50 - 600 ml), no complications such as abdominal haemorrhage, visceral injury, pancreatic leakage and infection were observed. All the patients were healed well, the average hospital stay after an operation was 6 days. The average expense of each patients could save 8050 yuan because Endo-GIA was not used.
Spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy, which shorten the operating persistence time with less hemorrhage is a safe, effective and low-cost minimally invasive surgery in selective cases.
评估在腹腔镜脾切除术中使用LigaSure血管闭合系统联合超声刀采用脾蒂两步离断法离断脾周韧带的安全性及实用性。
总结分析32例行上述方法腹腔镜脾切除术患者的手术方法及疗效。男性4例，女性28例，年龄中位数36岁（范围16 - 64岁）。脾脏平均大小为17 cm（范围11 - 23 cm）。19例为特发性血小板减少性紫癜（ITP），6例为遗传性球形红细胞增多症（HS）（其中5例为同一家族成员），3例为溶血性贫血（HA），2例为脾损伤伴血肿感染，1例为伊文氏综合征，1例为白血病。采用LigaSure联合超声刀离断脾周韧带，当脾蒂充分游离后，采用LigaSure脾蒂两步离断法离断脾蒂。第一步在胰尾处用LigaSure非离断性阻断脾蒂，第二步在脾旁阻断并离断。
32例手术均顺利完成，平均手术时间70分钟（55 - 130分钟），估计术中出血量200 ml（50 - 600 ml），未观察到腹腔出血、脏器损伤、胰漏及感染等并发症。所有患者恢复良好，术后平均住院天数为6天。因未使用Endo - GIA，每位患者平均费用节省8050元。
在腹腔镜脾切除术中使用LigaSure血管闭合系统联合超声刀采用脾蒂两步离断法离断脾周韧带，缩短了手术持续时间，出血少，在选择性病例中是一种安全、有效且低成本的微创手术。
