Low Jee K, Ayiomamitis Georgios D, Hamoudi Akram, Ammori Basil J
Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, North Manchester General Hospital, University of Manchester, Manchester, UK.
Surg Laparosc Endosc Percutan Tech. 2011 Apr;21(2):e84-6. doi: 10.1097/SLE.0b013e31820afc7c.
The Pringle maneuver has its applications to minimize blood loss during hepatic resection. Splenic rupture during the Pringle maneuver in open liver surgery was described only in few cases. This is the first report of such a complication during laparoscopic surgery.
A 58-year-old woman sustained major splenic capsular rupture during laparoscopic right lateral hepatic sectionectomy (resection of segments VI to VII) for a colorectal metastasis. Surgery was carried out with the patient in the left lateral position. She became hypotensive during the second application of the Pringle maneuver secondary to spontaneous rupture of the splenic capsule. This was controlled with application of thrombogenic hemostatic agents. The patient received 12 units of blood transfusion. Her subsequent recovery was uneventful, and she was discharged on the sixth postoperative day.
Unexplained hypotension during laparoscopic liver resection and the application of the Pringle maneuver should raise suspicion of splenic hemorrhage and prompt a timely and adequate intervention.
普林格尔手法在肝切除术中用于减少失血。开放性肝脏手术中普林格尔手法期间脾破裂仅在少数病例中有描述。这是腹腔镜手术中发生此类并发症的首例报告。
一名58岁女性在因结直肠癌转移行腹腔镜右肝外侧段切除术（切除Ⅵ至Ⅶ段）时发生严重脾包膜破裂。手术在患者左侧卧位下进行。在第二次应用普林格尔手法时，由于脾包膜自发破裂，她出现了低血压。通过应用促凝血止血剂得以控制。患者接受了12单位的输血。她随后恢复顺利，并于术后第六天出院。
腹腔镜肝切除术中出现无法解释的低血压以及应用普林格尔手法时，应怀疑脾出血并及时进行充分干预。
