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目的：探讨应用脾动脉结扎法行全腹腔镜巨脾切除术的安全性、可行性及手术技巧。方法：将2010 年1 月1 日至2012 年1 月1 日因肝硬化门脉高压脾机能亢进巨脾患者随机分为腹腔镜脾切除（Laparoscopic Splenectomy，LS）组及开腹脾切除（Open Splenectomy，OS）组，比较两组的临床特征及围手术期差异。结果：LS 组与OS 组在性别组成、术前肝功能child 分级、年龄组成及脾脏长径方面均无统计学意义。LS 组手术时间比OS 组略长，但无统计学意义，LS 组术中出血量明显低于OS 组（P<0.01），LS 组术后进食、术后排气、引流管拔除及出院时间均明显早于OS 组（P<0.01）。结论：腹腔镜脾切除术为治疗门脉高压巨脾的一种有效、安全、可行的手术方式。

英文摘要:

Objective: To investigate the safety, feasibility and surgical techniques with splenic artery ligation in total laparoscopic massive splenectomy. Methods: From January 1, 2010 to January 1, 2012, patients with hypertension due to cirrhosis of the liver spleen hyperfunction massive splenectomy were randomly assigned into laparoscopic splenectomy group and Open Splenectomy group. Compare the two groups in clinical characteristics and differences in the perioperative period. Results: Between the two groups, the differences in gender composition, age, child classification and the diameter in the spleen were not statistically significant. LS group operative time was slightly longer than that in the OS group, but the difference had no statistical significance. LS group blood loss was significantly lower than that in the OS group (P<0.01). The time of postoperative feeding, farting, postoperative tube remove, postopera- tive hospital stay in LS group were significantly earlier than that in the OS group (P<0.01). Conclusions: Total laparoscopic massive splenectomy is safe, feasible and effective to treatment portal hypertension.

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