探讨探讨腹腔镜脾切除术（LS）治疗外伤性脾破裂（TSR）的疗效及体会。

回顾性分析2013年1月至2018年8月在中山大学附属第三医院粤东医院行手术治疗的27例TSR患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男19例，女8例；平均年龄（43±16）岁。车祸伤19例，坠落伤6例，其他外伤2例。根据脾损伤分级，Ⅰ级损伤1例，Ⅱ级损伤2例，Ⅲ级损伤17例，Ⅳ级损伤7例。根据手术方式将患者分为腔镜组（12例）和开腹组（15例）。观察两组患者围手术期情况。两组术中出血量、术后24 h视觉模拟评分法（VAS）评分等比较采用t检验。

腹腔镜1例因术中出血无法控制，中转开腹手术。其余患者手术均顺利完成。腔镜组术中出血量、术后24 h VAS评分、术后首次肛门排气时间和术后首次下床时间分别为（157±50）ml、（3.6±1.8）分、（2.8±0.7） d、（2.2±0.6） d，明显少于开腹组的（209±71） ml、（4.7±1.5）分、（3.5±0.9）d、（2.9±0.9）d （t=-2.166，-1.828，-2.126，-2.573；P<0.05）。两组患者均无发生死亡，无血栓形成。腔镜组出现发热1例，予吲哚美辛治疗5 d痊愈。开腹组切口感染2例，肺部感染1例，予换药和抗感染后治愈。

与传统开腹脾切除术相比，LS治疗TSR可减少术中出血量、减轻术后疼痛，具有损伤小、恢复快的优势。

To evaluate the surgical efficacy and experience of laparoscopic splenectomy (LS) in the treatment of traumatic splenic rupture (TSR).

Clinical data of 27 TSR patients undergoing splenectomy in Yuedong Hospital, the Third Affiliated Hospital of Sun Yat-sen University from January 2013 to August 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 19 patients were male and 8 female, aged (43±16) years on average. Among them, 19 cases were diagnosed with traffic accident injuries, 6 cases of falling injuries and 2 cases of other injuries. According to the classification of spleen injury, 1 case was classified as grade Ⅰ injury, 2 cases as grade Ⅱ, 17 cases as grade Ⅲ and 7 cases as grade Ⅳ. All patients were divided into the LS group (n=12) and open splenectomy group (n=15). Perioperative conditions of two groups were observed. Intraoperative blood loss and postoperative 24-h visual analogue scale (VAS) score were statistically compared between two groups by t test.

In LS group, 1 case was converted to open surgery due to uncontrollable bleeding. Operations of the remaining patients were performed successfully. In LS group, the intraoperative blood loss, postoperative 24-h VAS score, the first postoperative anal exhaust time and the first postoperative ambulation time were (157±50) ml, 3.6±1.8, (2.8±0.7) d and (2.2±0.6) d, significantly lower than (209±71) ml, 4.7±1.5, (3.5±0.9) d and (2.9±0.9) d in open splenectomy group (t=-2.166, -1.828, -2.126, -2.573; P<0.05). No death, thrombosis were observed in either group. One case of fever was observed in LS group, who was cured with indomethacin for 5 days. In open splenectomy group, incisional infection occurred in 2 cases and lung infection in 1 patient, and all of them were healed after dressing change and anti-infection therapy.

Compared with the traditional open splenectomy, LS can reduce intraoperative blood loss, mitigate postoperative pain for TSR patients with the advantages of mild trauma and fast recovery.