脾動(dòng)脈栓塞聯(lián)合腹腔鏡巨脾切除術(shù)的臨床應(yīng)用

楊毅　肖群　唐華勇　陳小雪　賀彥宇　袁通立

【摘要】 目的：研究脾動(dòng)脈栓塞聯(lián)合腹腔鏡巨脾切除術(shù)的臨床應(yīng)用。方法：回顧性分析2014年1月-2019年6月于湖南省中醫(yī)藥高等專(zhuān)科學(xué)校第一附屬醫(yī)院行脾動(dòng)脈栓塞聯(lián)合腹腔鏡巨脾切除術(shù)20例患者的臨床資料。結(jié)果：20例患者中轉(zhuǎn)開(kāi)腹手術(shù)1例，完成腹腔鏡巨脾切除術(shù)19例;圍手術(shù)期接受異體輸血4例;手術(shù)時(shí)間140～400 min，平均（240±65）min;術(shù)中出血量50～800 ml，平均（222±184）ml;術(shù)后首次肛門(mén)排氣時(shí)間2～4 d，平均（2.7±0.6）d;術(shù)后住院時(shí)間7～26 d，平均（12.8±4.6）d;無(wú)出血、胰瘺等并發(fā)癥。結(jié)論：對(duì)于血小板過(guò)低患者，術(shù)前進(jìn)行充分評(píng)估后施行脾動(dòng)脈栓塞聯(lián)合腹腔鏡巨脾切除術(shù)是安全、有效的，且臨床療效滿(mǎn)意。

【關(guān)鍵詞】 腹腔鏡 脾切除術(shù) 巨脾 脾動(dòng)脈栓塞

doi：10.14033/j.cnki.cfmr.2020.16.047 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805（2020）16-0-03

Clinical Application of Splenic Artery Embolization Combined with Laparoscopic Splenectomy for Treatment of Giant Spleen/YANG Yi， XIAO Qun， TANG Huayong， CHEN Xiaoxue， HE Yanyu， YUAN Tongli. //Chinese and Foreign Medical Research， 2020， 18（16）： -119

[Abstract] Objective： To study the clinical application of splenic artery embolization combined with laparoscopic splenectomy for treatment of giant spleen. Method： The clinical data of 20 patients who underwent splenic artery embolization combined with laparoscopic splenectomy in the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine from January 2014 to June 2019 were retrospectively analyzed. Result： Among the 20 cases， 1 case was converted to open surgery， and 19 cases completed laparoscopic splenectomy. Four patients received allogeneic blood transfusion during the perioperative period. The operation time was 140 to 400 min， with an average of （240±65） min. Intraoperative blood loss was 50 to 800 ml， with an average of （222±184） ml. The first anal exhaust time after operation was 2 to 4 days， with an average of （2.7±0.6） days. The hospital stay after operation was 7 to 26 days， with an average of （12.8±4.6） days. There were no complications of bleeding or pancreatic fistula. Conclusion： For patients with low platelet count， splenic artery embolization combined with laparoscopic splenectomy after adequate preoperative evaluation is safe and effective， and the clinical efficacy is satisfactory.

[Key words] Laparoscopy Splenectomy Giant spleen Splenic artery embolization

First-authors address： The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine， Zhuzhou 412000， China

脾切除手術(shù)多用于脾外傷、門(mén)脈高壓癥、部分血液系統(tǒng)疾病中。由于肝硬化門(mén)脈高壓癥患者多伴巨脾，導(dǎo)致操作空間狹小，且側(cè)支循環(huán)豐富、凝血功能較差，使手術(shù)難度增加。以往主要采用開(kāi)腹手術(shù)，隨著醫(yī)療技術(shù)不斷發(fā)展，全腹腔鏡巨脾切除術(shù)逐漸被臨床應(yīng)用，且效果顯著[1-2]。但全腹腔鏡巨脾切除術(shù)也具有一定難度，風(fēng)險(xiǎn)較高，創(chuàng)面出血是常見(jiàn)的手術(shù)并發(fā)癥。術(shù)前血小板較低可導(dǎo)致手術(shù)風(fēng)險(xiǎn)進(jìn)一步增加。筆者所在醫(yī)院針對(duì)20例患者采取脾動(dòng)脈栓塞聯(lián)合全腹腔鏡巨脾切除術(shù)，效果良好，報(bào)道如下。

1 資料與方法

1.1 一般資料

回顧性分析2014年1月-2019年6月于湖南省中醫(yī)藥高等專(zhuān)科學(xué)校第一附屬醫(yī)院行脾動(dòng)脈栓塞聯(lián)合腹腔鏡巨脾切除術(shù)患者20例的臨床資料?！?br>