摘要
Abstract
Objective:To summarize hemostatic techniques for accidental splenic injury during laparoscopic radical gastrectomy and explore the efficacy of saline-soaked gauze compression followed by electrocoagulation through the gauze for controlling splenic sur-face hemorrhage.Methods:A retrospective analysis was conducted on clinical data of 162 patients who underwent laparoscopic radical gastrectomy from Jan.2020 to Dec.2024.Accidental intraoperative splenic injury occurred in 8 cases(4.9％),all classified as Grade I.Hemostasis techniques included monopolar high-power spray coagulation,bipolar electrocautery,and compression with saline-soaked gauze followed by monopolar electrocautery applied over the gauze.Results:Monopolar spray coagulation was used initially in 3 cases with superficial splenic bleeding.In 2 cases with deeper wounds,initial monopolar coagulation failed,and hemostasis was subsequently achieved with bipolar electrocautery.In 3 remaining cases,where bipolar electrocautery failed initially,hemostasis was successfully achieved using saline-soaked gauze compression followed by monopolar electrocautery applied over the gauze.Hemostasis was success-fully achieved laparoscopically in all 8 cases.Intraoperative blood loss ranged from 10 to 50 mL,with a mean of(30±16.4)mL.No sig-nificant differences were found in pre-versus postoperative hemoglobin(P=0.094),white blood cell(P=0.444),or platelet(P=0.570).The mean operative time for patients with accidental splenic injury was(234.375±24.55)min,compared to(226.43±26.83)min for routine procedures,with no significant difference(P=0.416).The hospital stay for patients with accidental splenic injury was(16.13±1.96)d,versus(16.25±4.26)d for routine surgery patients,with no significant difference(P=0.933).No post-operative complications such as infection or splenic dysfunction occurred.All patients were discharged uneventfully.Conclusions:Grade I splenic injuries can be effectively managed using monopolar spray coagulation,bipolar electrocautery,or saline-soaked gauze compres-sion followed by electrocautery over the gauze.Monopolar high-power spray coagulation is suitable for small wounds but carries a risk of enlarging the injury if used inappropriately.Bipolar electrocautery offers superior hemostasis compared to monopolar coagulation but requires instrument exchange and increasing costs.The method of saline-soaked gauze compression followed by electrocautery over the gauze is straightforward and practical,and demonstrates reliable efficacy.关键词
胃癌根治术/腹腔镜检查/脾损伤/止血/临床经验Key words
Radical gastrectomy for gastric cancer/Laparoscopy/Splenic injury/Hemostasis/Clinical experience分类
医药卫生
