Rosen Michael, Brody Fred, Walsh R Matthew, Ponsky Jeffrey
Department of General Surgery, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, 9500 Euclid Ave, Bldg A-80, Cleveland, OH 44195, USA.
Arch Surg. 2002 Dec;137(12):1348-52. doi: 10.1001/archsurg.137.12.1348.
Laparoscopic splenectomy (LS) is the procedure of choice for elective splenectomy. Splenomegaly may preclude safe mobilization and hilar control using conventional laparoscopic techniques. Hand-assisted LS (HALS) may offer the same benefits of minimally invasive surgery for splenomegaly while allowing safe manipulation and splenic dissection.
A retrospective review of patients with splenomegaly undergoing conventional LS or HALS was performed.
Tertiary care referral center.
Hand-assisted LS was performed at the start of the operation for patients with splenomegaly; splenomegaly was determined by palpation of the splenic tip extending to the midline or the iliac crest, or by a craniocaudal splenic length of greater than 22 cm. Splenomegaly was defined as a splenic weight of greater than 700 g after morcellation.
Patient demographic characteristics, operative indications, splenic weight after morcellation, morbidity, mortality, and clinical outcomes were evaluated.
Forty-five patients with splenomegaly were identified: 31 underwent standard LS and 14 underwent HALS. The HALS group had significantly larger spleens than the conventional LS group (mean weight, 1516 vs 1031 g; P =.02). Mean operative time (177 vs 186 minutes; P =.89), estimated blood loss (602 vs 376 mL; P =.17), and length of hospital stay (5.4 vs 4.2 days; P =.24) and complication rates (5 [36%] of 14 vs 5 [16%] of 31; P =.70) were similar between the HALS and the standard LS groups. No perioperative mortality occurred.
Hand-assisted LS is a safe and efficacious procedure for these extremely difficult cases. Hand-assisted LS provides the benefits of a minimally invasive approach in cases of splenomegaly.
腹腔镜脾切除术（LS）是择期脾切除术的首选术式。脾肿大可能会妨碍使用传统腹腔镜技术进行安全的游离和脾门控制。手辅助腹腔镜脾切除术（HALS）对于脾肿大患者可能具有与微创手术相同的益处，同时能实现安全操作和脾脏解剖。
对接受传统LS或HALS的脾肿大患者进行回顾性研究。
三级医疗转诊中心。
对于脾肿大患者，在手术开始时进行手辅助LS；脾肿大通过触诊脾尖延伸至中线或髂嵴来确定，或通过脾的头尾径长度大于22 cm来确定。脾肿大定义为粉碎后脾脏重量大于700 g。
评估患者的人口统计学特征、手术指征、粉碎后脾脏重量、发病率、死亡率和临床结局。
确定了45例脾肿大患者：31例行标准LS，14例行HALS。HALS组的脾脏明显大于传统LS组（平均重量，1516 vs 1031 g；P = 0.02）。HALS组与标准LS组之间的平均手术时间（177 vs 186分钟；P = 0.89）、估计失血量（602 vs 376 mL；P = 0.17）、住院时间（5.4 vs 4.2天；P = 0.24）和并发症发生率（14例中的5例[36%] vs 31例中的5例[16%]；P = 0.70）相似。未发生围手术期死亡。
对于这些极具挑战性的病例，手辅助LS是一种安全有效的手术方式。手辅助LS在脾肿大病例中提供了微创手术的益处。
