Dexter S P, Martin I G, Alao D, Norfolk D R, McMahon M J
Leeds Institute for Minimally Invasive Therapy, General Infirmary, United Kingdom.
Surg Endosc. 1996 Apr;10(4):393-6. doi: 10.1007/s004649910072.
Elective splenectomy is often performed for hematological diseases, some of which cause only moderate enlargement of the spleen. The avoidance of an extensive upper abdominal incision is desirable in such cases and laparoscopic splenectomy offers significant potential advantages over the open operation if it can be performed safely and economically.
Eight consecutive patients underwent laparoscopic splenectomy. The operation was carried out with the patient at 40 degrees in the right lateral position so that rotating the operating table would make a full right lateral position possible. After fenestration of the gastrocolic omentum and division of the short gastric vessels, this position allowed the spleen to be pushed up under the diaphragm to facilitate access to the splenic vessels and the hilum. Vessels were divided individually between clips.
All eight cases were completed laparoscopically. Mean length of operation was 259 min (range 230-285). Postoperative stay ranged from 2 to 7 days (median 4 days). There was no mortality, although minor complications did occur in three patients.
We found laparoscopic splenectomy to be a safe and feasible procedure for the elective removal of the moderately enlarged spleen.
择期脾切除术常用于治疗血液系统疾病，其中一些疾病仅导致脾脏中度肿大。在此类病例中，避免广泛的上腹部切口是可取的，并且如果能够安全且经济地进行，腹腔镜脾切除术相对于开放手术具有显著的潜在优势。
连续8例患者接受了腹腔镜脾切除术。手术时患者取右侧卧位40度，以便通过旋转手术台实现完全的右侧卧位。在切开胃结肠韧带并离断胃短血管后，此体位可将脾脏向上推至膈肌下方，便于显露脾血管和脾门。血管在夹闭之间逐一离断。
所有8例手术均通过腹腔镜完成。平均手术时间为259分钟（范围230 - 285分钟）。术后住院时间为2至7天（中位数4天）。无死亡病例，尽管3例患者出现了轻微并发症。
我们发现腹腔镜脾切除术是择期切除中度肿大脾脏的一种安全可行的手术方法。
