Analysis Of Anatomical Basis And Clinical Application Of Laparoscopic Anatomical Splenectomy

Objective:To evaluate the laparoscopic anatomy of the spleen vessels and its clinical application . Methods:47 cases of laparoscopic splenectomy From Sept. 2002 to Feb. 2006 , were selected among them19 cases of thalassemia ,21 cases of portal hypertension because of cirrhosis , 2 cases of ITP(idiopathic thrombocytopenic purpura),2 cases of hereditary spherocytosis,1 case of spleen angioma,1 case of spleen cyst and 1 case of primary hypersplenism .. The splenic vessels were investigated and categorized,. and different treatments for different categories were studied . Results:The total laparoscopic procedure was successful in all cases . Concomitant surgical procedures included 14 extensive esophagogastric devascularizations and 3 cholecystectomies. There was one conversion due to extensive bleeding. The splenic vessels were categorized asⅠtype(34/47,72.3%),Ⅱtype(9/47,19.2%) andⅢtype(2/47,4.25%).The splenic artery was ligated in 43 cases and the hilar vessels were resected by dissecting and ligating respectively in 45 cases. Operation time averaged at(110±35)min; the average intraoperative blood loss (160±87) ml. Conclusion:In spite of the prominentⅡtype of the spleen vessels ,the splenic artery can be dissected and ligated at the superior edge of the pancreatic tail to decrease artery supply to the spleen. The hilar vessels can be resected by dissecting and ligating respectively . The splenic artery ligation and hilar vessels resection by dissecting and ligating respectively are technically feasibility in hands with laparoscopic expertise and can decrease intraoperative bleeding and chances of pancreas injury.