摘要
目的探讨腹腔镜脾切除术,包括内结扎法与器械结扎血管法,辅以中药扶正,中西医结合治疗各种原因导致脾肿大的可行性与临床效果。方法自2007年10月至2011年2月,采用行腹腔镜脾切除术合并中西医结合治疗各种脾肿大疾病28例,包括遗传性球形红细胞增多症11例、原发性脾肿大9例、血小板减少性紫癜3例,肝硬化脾肿大5例。术前针对不同病因给予不同中药扶正、对症治疗,在腹腔镜下先游离显露脾动脉,用丝线结扎、切断,再逐一游离显露脾静脉,用丝线结扎、切断,或用Endo-GIA或者hem-o-lok等器械结扎脾门血管。用超声刀逐步游离、切断脾周围韧带,将脾脏置入污物袋,捣碎取出。术后辅以中药辅助治疗。结果 2例肝硬化患者因术中出血中转开腹手术,其余均经腹腔镜完成,其中内结扎法完成9例,应用Hem-o-lok法7例,应用内镜直线切割闭合器法10例;出血量为10～25ml,平均15ml,切脾时间100～180min,平均130min;取脾时间40～60min;术中、术后无输血;术后无明显出血、腹腔感染等并发症发生。术前、术后均辅以中药扶正治疗,术后贫血得以纠正,血红蛋白2周后恢复正常,遗传性球形红细胞增多症患者血小板术后1周明显增多,辅以中药抗凝,4周后恢复正常。结论采用腹腔镜脾切除合并中西医结合治疗各种脾肿大患者微创、安全、有效;根据不同患者采用不同血管内或器械结扎法,临床效果相同,经济实用;中药扶正,提高治疗效果。
Objective The objective is to explore the feasibility and clinical therapeutic effects of treatment of splenomegaly by combination of surgery and traditional Chinese medicine. The surgery is laparoseopic splenectomy including endoligature, Hem-o-lok or Endo-GIA ligature to spleen hilum, while traditional Chinese medicine supporting therapy is used for anemia correction and platelet decrease before and after surgery. Methods Clinical data of 28 cases of splenomegaly undergoing combination of laparoscopic splenectomy and traditional Chinese medicine from October 2007 to February 2011 were retrospectively analyzed. Among them, there were 11 cases with Hereditary Spheroeytosis, 9 cases with Primary Splenomegaly,3 cases with Thrombecytopenic purpura and 5 cases with Cirrhotic Splenomegaly. Before operation, we used different Chinese medicine supporting therapy for anemia correction and improving patients＇health status according to different etiological factors. The splenectomy was started with laparoscopic dissection of the splenic artery, followed by ligation and transection using silk threads. Splenic vein was treated in the same way as the splenic artery. Silk ligature to spleen hilum during laparoscopie spleneetomy could be replaced by the Endo-GIA or hem-o-lock. Perisplenic ligaments and vessels were isolated and transected by ultrasonic scalpel. After the spleens were mobilized, the spleens were put into the bag and crushed, then taken out successfully. After operation, we used Chinese medicine supporting therapy to prevent the sudden increase of the platelets. Results Two cases of Cirrhotic Splenomegaly were transfered to open procedure because of bleeding. The other laparoscopic splenectomy was successfully completed. During laparoscopic spleneetomy, endoligature was used in 9 cases, Hem-o-Ink in 7 cases and Endo-GIA in 10 cases. The intra-operative blood loss was 10-25 mL （mean, 15 mL）. The laparoscopic splenectomy time was 100-180 rain （mean, 130 min）. The time used for the spleen removal was fi＇
出处
《中华腔镜外科杂志（电子版）》
2011年第2期49-52,共4页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
结扎法
腹腔镜
脾切除术
中西医结合
Laparoseopie Spleneetomy
Silk ligature
Integrated traditional
Chinese and western medicine
