Yuan R H, Yu S C
Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei.
J Laparoendosc Adv Surg Tech A. 1998 Oct;8(5):269-72. doi: 10.1089/lap.1998.8.269.
This report introduces our new technique in laparoscopic splenectomy. A 2-mm minilaparoscope and a conventional 10-mm laparoscope were used alternatively during the procedure, with a result of nearly no visible scar after the operation. Two young females diagnosed with idiopathic thrombocytopenic purpura, refractory to medical treatment, underwent laparoscopic splenectomy in our hospital. The whole procedure was finished through one 12-mm port (supraumbilical) and three 2-mm ports (subxiphoid, left midclavicular, and left midaxillary). The short gastric vessels and splenic vessels were clipped and divided by Endo-GIA II (U.S. Surgical Corp., Norwalk, CT) that was applied through the 12-mm port. The spleen was placed in a bag and was fractured to be removed piece by piece. A drain tube was not necessary after meticulous hemostasis. Two weeks after the operation, only three tiny wounds, resembling mosquito bites, were present at the left subcostal region. In conclusion, minilaparoscopic splenectomy is feasible and safe for patients with idiopathic thrombocytopenic purpura, and may ultimately be an alternative choice for patients desiring superior cosmesis.
本报告介绍了我们在腹腔镜脾切除术中的新技术。手术过程中交替使用了2毫米微型腹腔镜和传统的10毫米腹腔镜，术后几乎没有可见疤痕。两名诊断为特发性血小板减少性紫癜且药物治疗无效的年轻女性在我院接受了腹腔镜脾切除术。整个手术通过一个12毫米端口（脐上）和三个2毫米端口（剑突下、左锁骨中线和左腋中线）完成。胃短血管和脾血管通过经12毫米端口置入的Endo-GIA II（美国外科公司，诺沃克，康涅狄格州）进行夹闭和离断。脾脏装入袋中，破碎后逐块取出。细致止血后无需放置引流管。术后两周，左肋下区域仅出现三个类似蚊虫叮咬的微小伤口。总之，微型腹腔镜脾切除术对于特发性血小板减少性紫癜患者是可行且安全的，最终可能成为追求更佳美容效果患者的替代选择。
