Kuriansky J, Bilik R, Shabtai M, Avigad I, Ayalon A
Dept. of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer.
Harefuah. 1999 Mar 1;136(5):341-3, 420.
Laparoscopic splenectomy is effective and technically feasible for treating various hematological diseases such as idiopathic thrombocytopenic purpura (ITP), congenital spherocytosis, hemolytic anemia, and Hodgkin's lymphoma. An anterior approach to the vascular pedicle is usually described. However, in this approach to the splenic hilum, the dissection of the splenic artery is frequently difficult. The laparoscopic posterolateral approach involves dissection of the posterolateral attachments to the diaphragm, followed by the dissection and ligation of all splenic branches near the splenic parenchyma. We used it in 9 adults and 4 children: 11 patients had ITP, 1 spherocytosis and 1 Hodgkin's lymphoma. This procedure was completed in 13 patients, but in 2 it had to be converted to open surgery. Mean operating time was 3 hours and mean postoperative stay 3 days. Blood transfusion was not required and there were no postoperative complications. Laparoscopic splenectomy is safe in both adults and children, and the posterolateral approach provides excellent visualization and allows control of the branches of the splenic vein and artery in the splenic hilum.
腹腔镜脾切除术对于治疗各种血液系统疾病，如特发性血小板减少性紫癜（ITP）、先天性球形红细胞增多症、溶血性贫血和霍奇金淋巴瘤，是有效且技术上可行的。通常描述的是血管蒂的前路手术方法。然而，在这种脾门入路中，脾动脉的解剖常常很困难。腹腔镜后外侧入路包括解剖脾脏与膈肌的后外侧附着处，然后在脾实质附近解剖并结扎所有脾分支。我们将其应用于9名成人和4名儿童：11例患者患有ITP，1例患有球形红细胞增多症，1例患有霍奇金淋巴瘤。该手术在13例患者中完成，但有2例不得不转为开放手术。平均手术时间为3小时，平均术后住院时间为3天。无需输血，且无术后并发症。腹腔镜脾切除术在成人和儿童中都是安全的，后外侧入路能提供良好的视野，并能控制脾门处的脾静脉和动脉分支。
