摘要
目的探讨内结扎法腹腔镜脾切除术的应用解剖及其手术要点。方法对41例相关血液病儿采用内结扎法进行腹腔镜脾切除术，其中遗传性球形红细胞增多症25例，特发性血小板减少性紫癜13例，脾性粒细胞减少症3例。术前用彩色多普勒血流显像探测脾蒂血管解剖类型、走行及其与胰腺的关系，并与术中所见做对比。结果彩色多普勒血流显像显示脾蒂血管走行与胰腺的关系呈Ⅰ型24例，Ⅱ型17例；脾血管分支呈分散型31例，集中型10例，与术中记录脾血管分支类型（95％）及其与胰腺的关系（90％）基本符合。本组41例腹腔镜脾切除术均获得成功，无严重手术并发症发生。手术时间（114±31）min，出血量（51±23）ml。结论彩色多普勒血流显像可明确脾蒂血管解剖分支类型、走行及其与胰腺的毗邻关系；用内结扎法实施腹腔镜脾切除术安全、可靠。
Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature （endoligature） instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results. Methods 41 children patients underwent laparoscopic splenectomy with this technique （endoligature） for various hematologic and autoimmune disorders, including 25 cases of hereditary spherocytosis, 13 idiopathic thrombocytopenia purpura, and 3 hypersplenic granulocytopenia. The anatomy of splenic pedicle, the adjacent relation between splenic vessel and pancreas were detected by color Doppler uhrasonography preoperatively. The above-mentioned parameters were compared with that found intraoperatively. Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17. In 31 cases, the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography. These characters were largerly identified by laparoscopic laparotomy, and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler. There was no serious complication. The mean operating time was （114 ± 31 ） rain, the estimated blood loss was （51 ±23 ） ml. Conclusions Ultrasonography could identify the anatomic type of splenic vessel, and its relation with the pancreas. Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.
出处
《中华普通外科杂志》
CSCD
北大核心
2009年第10期842-844,共3页
Chinese Journal of General Surgery
基金
国家十一五科技支撑计划项目（2006BAI05A06）
河北省科学技术研究与发展项目（052761659）
