腹腔镜；脾脏；解剖_____腹腔镜；脾脏；解剖

脾叶动脉相关的腹腔镜下脾脏大体解剖的临床应用研究

http://www.100md.com 《腹腔镜外科杂志》 2006年第5期

腹腔镜；脾脏；解剖,,腹腔镜；脾脏；解剖,1资料与方法,2结果,3讨论,参考文献：

     【摘要】目的：腹腔镜下对与脾叶动脉相关的脾脏大体解剖观察，研究腹腔镜脾切除术(LS)时脾蒂血管的最佳处理方式，并探讨腹腔镜治疗部分性脾栓塞术脾脏疾病的可行性。方法：对30例完全腹腔镜脾切除时对脾切迹分布、脾叶动脉阻断后脾供血界面变化、脾叶动脉处理方式进行归纳分析。结果：30例LS观察脾切迹分布：脾前缘切迹一个6例，占20%；二个13例，占43.3%；三个11例，占36.7%。脾叶动脉阻断后脾供血界面：分界清晰28例，占93.3%；分界模糊2例，占6.7%。界面分布在脾切迹所在平面或其延长线上，而与之相对的脾门区基本无二级血管，为脾叶动脉血管间隙。LS需要结扎、夹闭的脾叶动脉数：二支19例，占63.3%；三支7例，占23.3%；四支4例，占13.3%。腹腔镜下脾蒂血管处理方法：电凝+超声刀分离、钛夹+线结扎脾叶动脉23例，占76.7%；超声刀分离+ EndoGIA 6例，占20%；超声刀分离、线结扎+LigaSure 1例，占3.3%。30例LS中无术中凶险出血，无术中副损伤，无中转开腹。结论：LS时用电凝+超声刀分离、钛夹+线结扎脾叶动脉的“二级脾蒂离断术”处理脾蒂血管安全可靠，更符合我国医疗消费水平。应用腹腔镜行脾脏叶动脉或段动脉结扎，对临床上需要行部分性脾栓塞术(PSE)疾病的治疗将是一种新的微创治疗方法。

    【关键词】腹腔镜；脾脏；解剖

    Research of the clinical application on anatomy of splenic lobial artery in laparoscopic splentomy

    WANG Lianchen,HU Sanyuan,ZHANG Guangyong,et al.

    Dept.of General Surgery,the Second Affiliated Hospital,Xuzhou Medical College,Xuzhou 221006,China;Dept.of General Surgery,Qilu Hospital,Shandong University

    【Abstract】 Objective:To sdudy the suitable way of treating vessels in laparoscopic splenectomy(LS) through summing up and classifying the distribution of spleen lobial artery.To investigate feasibility on laparoscopic treatment splenic disease which need block the splenic artery in LS.Methods:The anatomy of splenic artery and the bloodsupply interface after blocking the splenic artery were analyzed in 30 cases reaceiving laparoscopic splenectomy.Results:The distribution of splenic impression was observed in 30 cases of laparoscopic splenectomy.One anterior impression:6 case(20%),two:13 cases(43.3%),three:11 cases(36.7%).The bloodsupply interface after blocking the splenic artery:28 cases(93.3%)had clear interface,2 cases(6.7%)had not clear interface.Bloodsupply interface locates in the plane or elongation of splenic impression.The number of spleen lobial artery which needed to be ligated by suture or occlused by titanium clips:19 cases(63.3%) were two lobial artery,7 cases (23.3%) were three,4 cases (13.4%) were four.Methods of treating spenic vessels:diverging with coagulation+ultrasonic knife,treating vessels with titanium clips+ligation were 23cases(76.7%).titanium clips+EndoGIA were 6cases(20%).Ultrosonic knife+LigaSure were case(3.3%).There was not dangerous bleeding,side injury and conversion to open surgery.Conclusions:Diverging with coagulation+ultrasonic knife,treating vessels with titanium clips+ligation in LS is a safe procedure.It's a suitable operation to the living condition of our country.The management of ligating lobial artery or segmental artery under laparoscopy may be a new and small invasive method to those patients who need receive partial splenic embolization. ......

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