| Objiective To sdudy the suitable way of treating vessels in laparoscopic splenectomy and the feasibility of replacing splenic embolization with lapaoscopic technique through summing up the imaging anatomy of spleen lobial arteryMethods 52cases who have no splenic diseases were selected to perform DSA.the data of splenic artery were collected to classify the distribution of splenic artery and measure the caliber of the terminal spleen artery .At the same time the distribution of spleen lobial artery were classified , the lengh and the Caliber of spleen lobial artery was measured.The distribution of splenic impression, the anatomy of splenic artery and the blood-supply interface after blocking the splenic artery was analyzed in 30 cases receiving laparoscopic splenectomy..Results In these 52 data the distribution of branches of splenic artery at the hilum of spleen was as follows: distributed type :46cases (88.5%), compact type:6cases(l1.5%). There is no significant difference compared to traditional data (P>0.1). The caliber of terminal splenic branch:maximum 7.8mm, minimum 4.8mm,mean6.37 ± 0.59mm. It is smaller than that large size titanium clips can clip (12.5mm). The caliber of superior spleen lobial artery:maximum 4.7mm ,minimum2.9mm ,mean3.96 ± 0.41mm. The caliber of inferior spleen lobial artery:maximum 4.2mm,minimum2.3mm,mean 3.23 ± 0.44mm. It is smaller than that middle size titanium clips can clip (8.8mm). The lengh of spleen lobial artery:maximum 66.2mm,minimum 21.5mm,mean44.7 ± 9.6mm.So it is easy to diverge lengh of vessel of 22mm to 24mm to ligate and clip. The distribution of spleen lobial artery:onebranch 0 cases,two branch 42cases (80.8%),three branch 10 cases(19.2%), more branch 0 cases.The distributon of splenic impression observed in 30 cases of laparoscopic splenectomy:anterior impression:one6case(20%),two 13cases(43.3%)three 11 cases(36.7%) . The blood-supply interface after blocking the splenic artery:having clear interface28cases(93.3%), no clear interface 2cases(6.7%).Blood-supply interface locates in the plane or elongation of splenic impression.The number of spleen lobial artery which needed to be ligated by suture or occlused by titanium clip:one Ocase, two 19cases(63.3%) ,three 7cases (23.3%) ,four 4 cases (13.4%),five or more 0 case. Methods of treating spenic vessels:diverging with coagulation+ultrasonic knife,treating vessels with titanium clips+ligation 23cases(76.7%).titanium clips+Endo-GIA 6cases(20%). Ultrosonic knife+Ligasure lcase(3.3%).There was no dangerous bleeding,no side injury ,no conversion to open sugery.All pations recover smoothly.Conclusion:From the imaging anatomy of spleen artery under USA we can cocluderthe maximum caliber of both terminal spleen artery and spleen lobial artery is smaller than the diameter that large size can clip.The lengh of spleen lobial artery is long enough to be diverged and ligated in LS. So it is safe to diverge vesselswith coagulation+ultrasonic knife and treate vessels with titanium clips+ligation .In china it is more suitable than other methods as according to peoples' living condition.The observation of the blood-supply interface after blocking the splenic artery in LS gives a further evidence to the theory that splenic blood-supply is segmentally.Ligating spenic lobial artery or its branch canlead to a clear blood-supply interface,which lead to a safe and effective method to treat splenic trauma: ligating lobial artery or segmental artery under laparoscopy.,which may be a new and small invasive method to those patients who need receive partial splenic embolization..Under laparoscopy we found that blood-supply interface lies in the plane or elongation of splenic impression .So the splenic impression can be a anatomic landmark to help the surgeon to avoid dangerous hemorrhea when diverging spleen lobial artery in LS.This study uses the direct-viewing of laparoscopy to describe the splenic vivisect related to spleen lobial artery .Which offers a new method to study vivisect... |
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