杨毅　肖群　唐华勇　陈小雪　贺彦宇　袁通立

【摘要】 目的：研究脾动脉栓塞联合腹腔镜巨脾切除术的临床应用。方法：回顾性分析2014年1月-2019年6月于湖南省中医药高等专科学校第一附属医院行脾动脉栓塞联合腹腔镜巨脾切除术20例患者的临床资料。结果：20例患者中转开腹手术1例，完成腹腔镜巨脾切除术19例;围手术期接受异体输血4例;手术时间140～400 min，平均（240±65）min;术中出血量50～800 ml，平均（222±184）ml;术后首次肛门排气时间2～4 d，平均（2.7±0.6）d;术后住院时间7～26 d，平均（12.8±4.6）d;无出血、胰瘘等并发症。结论：对于血小板过低患者，术前进行充分评估后施行脾动脉栓塞联合腹腔镜巨脾切除术是安全、有效的，且临床疗效满意。

【关键词】 腹腔镜 脾切除术 巨脾 脾动脉栓塞

doi：10.14033/j.cnki.cfmr.2020.16.047 文獻标识码 B 文章编号 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

脾切除手术多用于脾外伤、门脉高压症、部分血液系统疾病中。由于肝硬化门脉高压症患者多伴巨脾，导致操作空间狭小，且侧支循环丰富、凝血功能较差，使手术难度增加。以往主要采用开腹手术，随着医疗技术不断发展，全腹腔镜巨脾切除术逐渐被临床应用，且效果显著[1-2]。但全腹腔镜巨脾切除术也具有一定难度，风险较高，创面出血是常见的手术并发症。术前血小板较低可导致手术风险进一步增加。笔者所在医院针对20例患者采取脾动脉栓塞联合全腹腔镜巨脾切除术，效果良好，报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2014年1月-2019年6月于湖南省中医药高等专科学校第一附属医院行脾动脉栓塞联合腹腔镜巨脾切除术患者20例的临床资料。……