腹腔镜下三明治缝合修补技术在严重钝性脾脏外伤保脾手术中的应用.pdfVIP

中华创伤杂志2014 年4 月第30 卷第4 期 Chin J Trauma , April 2014 , Vo l. 30 , No.4 .313 . ·胸腹部损伤· 腹腔镜下三明治缝合修补技术在严重 钝性脾脏外伤保脾于术中的应用 林恒甫陈盈达林耿立陈石池 [摘要] 目的 评价腹腔镜下三明治缝合技术在严重钝性脾脏破裂保脾手术治疗中的应用 与效果。 方法 回顾性分析24 例因钝性伤造成脾脏严重破裂非于术治疗失败后，接受腹腔镜r 三明治缝合修补技术行止血与保脾于术患者，评价腹腔镜下三明治缝合保脾手术的技巧、于术结 果、术后恢复及随访结果等。 结果 24 例患者中， 21 例 (88% )行腹腔镜下三明治缝合修补技 术完成止血及保脾， 2 例因脾脏破裂伤复杂须转为腹腔镜下脾脏切除术，1 例因术中血流动力学不 稳定转为剖腹手术切除脾脏。止血时间(36.7 :t 22.0)min ，手术时间(136.3 土 40.3) min; 术中失血 量(1 598.0 :t 940.0)ml; 住院天数(1O.8 :t 5.4)d。患者均康复出院，无死亡。随访3 个月，无再出 血、脾脏完全梗死、脾脏版肿等并发症发生。 结论 腹腔镜下三明治缝合修补技术可有效应用于 严重钝性伤患者的保脾于术。 {关键词] 腹部损伤; 牌; 破裂; 腹腔镜 Laparoscopic sandwich repair technique for spleen salvage after high-grade blunt splenic trauma Lin Hengf扫 ， Chen Ying巾， μn Gengli , Chen Shichi. Department 01 Surgery , Far-eastern Memorial Hos- pital , Taipei 22060 , Taiwan Corresponding author: Chen Shichi , Tel: 00886-2-2356-2168 , Email: scchen@ ntu. edu. tw [Abstract] Objective To evaluate the effect of laparoscopic sandwich repair technique in spleen salvage for patients with high-grade blunt splenic trauma. Methods A retrospective study was per- formed in 24 patients with high-grade blunt splenic trauma undergone sandwich repair laparoscopically for hemostasis and spleen preservalion after the failed non-operative therapy. Surgical techniques , surgical outcomes , postoperative recovery , and follow-up results were evaluated. Results Of all , 21 patients (88%) underwent laparoscopic sandwich repair for hemostasis and spleen prese凹ation successfully; 2 were converted 10 the laparoscopic splenectomy due to complex splenic rupture; 1 was converted to an open splenectomy due to unstable hemodynamics. Mean time to reach hemostasis was (36. 7 土 22.0) mi- nutes and operation time was (136.3 :t 40.3) mi