Sakamoto Katsunori, Honda Goro, Kurata Masanao, Homma Yuki, Shinya Satoshi, Honjo Masahiko
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Asian J Endosc Surg. 2017 Feb;10(1):83-86. doi: 10.1111/ases.12325.
We employed a safe approach during laparoscopic splenectomy by first mobilizing the pancreatic tail and then dissecting the splenic vessels at the splenic hilum before mobilizing the spleen.
Patients were placed in the lithotomy position, and only the upper body was twisted to the right side. Five trocars were placed. After the bursa omentalis was opened, an avascular layer was identified behind the pancreas. This avascular layer was bluntly dissected, and the pancreatic tail was isolated from the retroperitoneum. The tissue surrounding the splenic hilum was dissected by a handling tape that was placed around the pancreatic tail. Because the spleen remained connected to the retroperitoneum with the splenorenal ligament, a good operative view of the splenic hilum was obtained with proper extension. After sufficient space was secured between the pancreatic tail and the spleen, the splenic vessels were divided with a linear stapler. The spleen was detached in the final stage.
The current standardized procedure is highly recommended for a safe laparoscopic splenectomy.
我们在腹腔镜脾切除术中采用了一种安全的方法，即在游离脾脏之前，先游离胰尾，然后在脾门处解剖脾血管。
患者取截石位，仅上半身向右侧扭转。置入5个套管针。打开网膜囊后，在胰腺后方识别出一个无血管层。钝性分离该无血管层，将胰尾与后腹膜分离。用一根绕过胰尾的操作带解剖脾门周围的组织。由于脾脏通过脾肾韧带与后腹膜相连，适当延长后可获得良好的脾门手术视野。在胰尾和脾脏之间获得足够的空间后，用直线切割缝合器切断脾血管。最后阶段将脾脏游离。
目前的标准化手术方法强烈推荐用于安全的腹腔镜脾切除术。
