手术体位对采用脾蒂结扎法行腹腔镜下脾脏切除术的影响

Influence of different operative position on laparoscopic splenectomy with splenic pedicle ligation

摘要:

目的   探讨不同手术体位对采用脾蒂结扎法行腹腔镜脾脏切除术（LS）的影响。方法   对采用脾蒂结扎法行LS的73例病例资料进行回顾性分析，比较仰卧分腿位、右斜卧位和完全右侧卧位采用脾蒂结扎法行LS的优缺点及影响。结果   该组采用仰卧分腿位22例，右侧斜卧位27例，完全右侧卧位24例。采用完全右侧卧位和右侧斜卧位的手术时间明显少于采用仰卧分腿位的手术时间（P <0.05），采用仰卧分腿位、完全右侧卧位和右侧斜卧位3组术中出血量、住院时间依次递减，但差异无统计学意义（P >0.05）。结论   脾蒂结扎法是LS较好地处理脾蒂的方法。采用仰卧分腿位、右斜卧位和完全右侧卧位行LS，3种体位各有优缺点，右斜卧位完全可以满足大多LS的操作要求和空间暴露，完全右侧卧位更加便于较大体积脾脏的腹腔镜下切除，把握好适应证，掌握3种体位的优缺点是关键。

Abstract:

Objective To investigate the effect of different operative position on laparoscopic splenectomy with splenic pedicle ligation. Methods Laparoscopic splenectomy with splenic pedicle ligation of 73 cases clinical data were retrospectively analyzed. The advantages, disadvantages and influence on laparoscopic splenectomy with splenic pedicle ligation of supine straddle position, right recumbent position and completely right lateral position were compared. Results Supine straddle position 22 cases, right recumbent position 27 cases, completely right lateral position 24 cases. The operation time of adopting right recumbent position and completely right lateral position was significantly shorter than that adopting supine straddle position (P < 0.05). The amount of intraoperative bleeding and hospitalization time were decreased gradually in the three groups of supine straddle position, completely right lateral position and right recumbent position, but no significant difference (P > 0.05). Conclusions Splenic pedicle ligation is a good method to deal with splenic pedicle in laparoscopic splenectomy. Supine straddle position, right recumbent position and completely right lateral position on laparoscopic splenectomy, these three operative positions have their advantages and disadvantages, right recumbent position can meet requirements for most laparoscopic splenectomy and exposure, completely right lateral position is more convenient for laparoscopic resection of large volume of spleen than the other operative position. It is the key that grasp the indications, master the advantages and disadvantages of the three operative positions.