关键词: 腹腔镜, 原位巨脾切除, 二级脾蒂离断法

Abstract: ［Abstract］ Objective To discuss the key points and safety of two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy for massive splenomegaly. Methods A retrospective analysis was conducted on the clinical data of 48 patients with massive splenomegaly receiving splenectomy from January 2013 and June 2017. According to the operation method the patients were divided into observation group（two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy） and the open group（traditional open splenectomy）. Results Forty?eight patients were successfully completed surgery， and 25 patients in study group were successfully completed two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy， no transfer to open surgery. The average operation in observation group was longer than that in open group（130.40±63.60 min vs 99.13±33.97 min），while the intraoperative blood loss（75.20±50.67 mL vs 206.09±116.77 mL） were less and postoperative hospital stay （8.24±2.20 d vs 11.00±3.49 d）were shorter（P<0.05）. The number of cases of abdominal cavity drainage tube was less inobservation group（P<0.05）， but the time of wipe out the abdominal cavity drainage in the both groups was almost the same. There were no significant differences in splenic fossa effusion， incision infection and fever between the two groups （P>0.05）. In observation group， the postoperative pleural effusion was better than that in the open group， and the difference was statistically significant （P<0.05）. No complications such as abdominal bleeding， abdominal infection， portal venous thrombosis， pancreatic fistula， gastric fistula， liver failure were found in both groups. The patients were followed up for 6 months after the operation. There were no complications of portal venous thrombosis and liver failure， and pleural effusion was absorbed. Conclusion Two steps of splenic pedicle transection in complete laparoscopic in situ splenectomy for massive splenomegaly is safe and reliable， and compared with traditional laparotomy method， less intraoperative bleeding， faster recovery.

Key words: laparoscopic, in situ splenectomy for massive splenomegaly, two steps of splenic pedicle transection