Trias M, Targarona E M, Espert J J, Cerdan G, Bombuy E, Vidal O, Artigas V
Service of General and Digestive Surgery, Hospital de S. Pau, Autonomous University of Barcelona, C/P Claret 167, 08025 Barcelona, Spain.
Surg Endosc. 2000 Jun;14(6):556-60. doi: 10.1007/s004640000149.
Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS patients.
We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided into group 1A, idiopathic thrombocytopenic purpura (ITP) (n = 48) and group 1B, HIV-related ITP (n = 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n = 8), and group 2B, spherocytosis (n = 11); (c) group 3, malignancy (n = 28); and (d) group 4, others (n = 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean follow-up of 24 +/- 18 months.
There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity, although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups 3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in >/=75% of patients (group 1A, 82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality was 6.2%, mainly due to deaths in group 4 (six of 22 patients).
LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.
腹腔镜脾切除术（LS）目前被视为自身免疫性血小板减少症（ITP）的首选治疗方法。然而，很少有报道描述LS在其他脾脏疾病中的应用，如恶性实体瘤和与脾肿大相关的病症。血液系统疾病具有特定的临床特征，可影响LS后的近期疗效。虽然LS的长期影响尚不清楚，但有人提出了脾种植的风险。因此，我们设计了一项研究，以分析原发性血液系统疾病对一系列LS患者近期和远期疗效的影响。
我们对1993年2月至1999年3月期间进行的111例LS进行了前瞻性分析。根据血液学指征将患者分为以下四组：（a）第1组，血小板计数低。该组进一步细分为1A组，特发性血小板减少性紫癜（ITP）（n = 48）和1B组，HIV相关ITP（n = 8）；（b）第2组，贫血。该组进一步细分为2A组，自身免疫性溶血性贫血（n = 8）和2B组，球形红细胞增多症（n = 11）；（c）第3组，恶性肿瘤（n = 28）；（d）第4组，其他（n = 8）。前瞻性记录近期疗效。在平均随访24±18个月后，复查血液学状况和远期并发症。
各组在中转率、输血需求和发病率方面无显著差异，尽管第3组的输血率和发病率略高。然而，第3组和第4组的住院时间明显长于第1组和第2组。长期随访显示，≥75%的患者血液学结果良好（1A组，82%；1B组，88%；2A组，88%；2B组，100%；3组，75%；4组，88%）。总体而言，远期发病率为8.3%，死亡率为6.2%，主要是由于第4组的死亡（22例患者中有6例）。
对于大多数血液学指征，LS是一种安全且可重复的手术，良性疾病的近期疗效相似，长期血液学反应与开放手术系列中观察到的标准结果相当。
