Poulin E C, Thibault C, DesCôteaux J G, Côté G
Department of Surgery, Hôpital du Saint-Sacrement, Université Laval, Québec, Canada.
Surg Laparosc Endosc. 1995 Aug;5(4):306-10.
We describe the course of a patient who underwent partial laparoscopic splenectomy after a fall while skiing. Computed tomography revealed intact liver and kidneys with fragmentation of the upper third of the spleen and a left upper quadrant hematoma. Splenic artery angiogram showed devascularization of the superior pole, and selective cannulation of the superior polar artery demonstrated extravasation of contrast media. The superior polar artery was embolized with three coils to control bleeding. After laparoscopic exploration, the patient underwent partial laparoscopic splenectomy of the superior pole, which consisted of ligating the short gastric vessels and incising the splenic parenchyma 6 to 8 mm above the ischemic demarcation line produced by embolization of the superior polar artery, where a deep transverse laceration was located. The specimen was retrieved in a plastic bag. Intraoperative blood loss was less than 50 ml, and the patient left the hospital on the 3rd postoperative day after an uneventful recovery. Partial laparoscopic splenectomy can be performed safely, and its role needs to be delineated.
我们描述了一名患者在滑雪摔倒后接受腹腔镜部分脾切除术的过程。计算机断层扫描显示肝脏和肾脏完好，脾脏上三分之一碎裂，左上象限有血肿。脾动脉血管造影显示脾上极血管离断，对脾上极动脉进行选择性插管显示有造影剂外渗。用三个弹簧圈栓塞脾上极动脉以控制出血。经腹腔镜探查后，患者接受了脾上极的腹腔镜部分脾切除术，包括结扎胃短血管，并在脾上极动脉栓塞产生的缺血分界线以上6至8毫米处切开脾实质，此处有一深部横向裂伤。标本装在塑料袋中取出。术中失血少于50毫升，患者术后恢复顺利，于术后第3天出院。腹腔镜部分脾切除术可安全实施，但需明确其作用。
