Targarona E M, Espert J J, Cerdán G, Balagué C, Piulachs J, Sugrañes G, Artigas V, Trias M
Service of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Avda. Padre Claret 167, 08025 Barcelona, Spain.
Surg Endosc. 1999 Jun;13(6):559-62. doi: 10.1007/s004649901040.
Laparoscopic splenectomy (LS) is gaining acceptance as an alternative to open splenectomy (OS). However, splenomegaly presents an obstacle to LS, and massive splenomegaly has been considered a contraindication. Analyses comparing the procedure with the open approach are lacking. The purpose of this study was to analyze the effect of spleen size on operative and immediate clinical outcome in a series of 105 LS compared with a series of 81 cases surgically treated by an open approach.
Between January 1990 and November 1998, 186 patients underwent a splenectomy for a wide range of splenic disorders. Of these patients, 105 were treated by laparoscopy (group I, LS; data prospectively recorded) and 81 were treated by an open approach (group II, OS analyzed retrospectively). Patients also were classified into three groups according to spleen weight: group A, <400 g; group B, 400-1000 g; and group C, >1000 g. Age, gender, operative time, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, length of stay, and morbidity were recorded in both main groups.
Operative time was significantly longer for LS than for OS. However, LS morbidity, mortality, and postoperative stay were all lower at similar spleen weights. Spleens weighing more than 3,200 g required conversion to open surgery in all cases. When LS outcome for hematologic malignant diagnosis was compared with LS outcome for a benign diagnosis, malignancy did not increase conversion rate, morbidity, and transfusion, even though malignant spleens were larger and accessory incisions were required more frequently. Postoperative hospital stay was significantly longer in malignant than in benign diagnosis (5 +/- 2.4 days vs. 4 +/- 2.3 days; p < 0. 05).
In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, who usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.
腹腔镜脾切除术（LS）作为开腹脾切除术（OS）的替代方法正逐渐被接受。然而，脾肿大是LS的一个障碍，巨大脾肿大一直被视为手术禁忌证。目前尚缺乏对该手术与开腹手术方法进行比较的分析。本研究的目的是分析脾脏大小对105例LS手术及近期临床结局的影响，并与81例接受开腹手术治疗的病例进行比较。
1990年1月至1998年11月期间，186例患者因各种脾脏疾病接受了脾切除术。其中，105例采用腹腔镜治疗（I组，LS；前瞻性记录数据），81例采用开腹手术治疗（II组，回顾性分析OS）。患者还根据脾脏重量分为三组：A组，<400g；B组，400 - 1000g；C组，>1000g。记录两个主要组别的年龄、性别、手术时间、围手术期输血情况、脾脏重量、中转率、脾脏取出方式（袋式或辅助切口）、术后镇痛、住院时间和发病率。
LS的手术时间明显长于OS。然而，在脾脏重量相似的情况下，LS的发病率、死亡率和术后住院时间均较低。所有脾脏重量超过3200g的病例均需中转开腹手术。将血液系统恶性疾病诊断的LS结局与良性诊断的LS结局进行比较时，尽管恶性脾脏更大且更频繁需要辅助切口，但恶性肿瘤并未增加中转率、发病率和输血量。恶性诊断后的术后住院时间明显长于良性诊断（5±2.4天对4±2.3天；p<0.05）。
对于脾肿大患者，LS是可行的，与开腹手术相比，其发病率、输血率更低，住院时间更短。对于这部分通常患有更严重血液系统疾病且发病率更高的患者，LS具有潜在优势。
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