目的 探讨全腹腔镜下脾切除术过程体位选择与显露技巧。 方法 2014年3月至2016年3月我们实施全腹腔镜下脾切除术11例,其中男性6例,女性5例,年龄5岁3个月至11岁10个月,平均年龄7岁5个月。病种包括:遗传球形红细胞增多症8例,地中海性贫血1例,特发性血小板减少性紫癜1例,脾梭形细胞血管内皮瘤1例。 结果 11例均在腹腔镜下完成手术。手术过程中采用平卧、右侧卧位或右侧斜卧位,均取前腹壁手术路径,术中结合体表缝线悬吊技术完成手术。手术时间92～213 min,平均135 min。术中失血50～200 mL,平均75 mL。术后患儿均顺利出院,术后住院时间7～10 d,平均8.7 d。 结论 全腹腔镜下脾切除术创伤小,是小儿脾脏手术的有效方法。选择合适体位及结合悬吊技术获得有效显露,有利于小儿全腹腔镜下脾切除术的顺利实施。
Objective To explore the position choice and exposure technique during laparoscopic splenectomy. Methods A total of 11 children underwent laparoscopic splenectomy from March 2014 to March 2016. There were 6 boys and 5 girls with an average age of 89(63～142)months. The causes were hereditary spherocytosis(n=8), Mediterranean anemia(n=1), idiopathic thrombocytopenic purpura(n=1)and spleen spindle cell hemangioendothelioma(n=1). Results All procedures were performed under laparoscope. Horizontal, right lateral or right arm recumbent positions were adopted. And the route of anterior abdominal wall was taken and surface suture suspension technique applied. The average operative duration was 135(92～213)min and average volume of blood loss 75(50～200)ml. All patients were discharged uneventfully after an average stay of 8.7(7～10)postoperative days. Conclusion s Laparoscopic splenectomy is efficacious since it causes only minor injury. Selecting a proper position and applying suspension technique will ensure the success of operations.
