Owera Anas, Hamade Ayman M, Bani Hani Omaya I, Ammori Basil J
Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
J Laparoendosc Adv Surg Tech A. 2006 Jun;16(3):241-6. doi: 10.1089/lap.2006.16.241.
Despite the benefits of the laparoscopic approach to splenectomy, its application in patients with massive splenomegaly (splenic weight >or= 1000 g) remains controversial. In this study we evaluated the safety and feasibility of laparoscopic splenectomy for massive splenomegaly compared with open splenectomy.
One surgeon applied the laparoscopic approach to splenectomy to all comers with massive splenomegaly, while other surgeons carried out the surgery through a laparotomy. The outcomes of the two approaches were compared on an intention-to-treat basis. Results of continuous variables are shown as medians.
Fifteen patients underwent laparoscopic splenectomy between 2000 and 2005, and 13 underwent open splenectomy between 1996 and 2003. The two groups were comparable for age, sex, American Society of Anesthesiologists score, and splenic weight (1.3 vs. 1.1 kg). There was one conversion (6.6%) to open surgery. Although laparoscopic splenectomy was associated with significantly longer operating time (175 vs. 90 minutes, P < 0.001), it carried lower postoperative morbidity and mortality (13.3 vs. 30.8% and 0 vs. 7.7%, respectively). Laparoscopic splenectomy was associated with significantly lower total dose (29 vs. 264 mg morphine-equivalent, P < 0.0001) and duration of opiate usage (1 vs. 4 days, P < 0.0001); duration of parenteral hydration (24 vs. 96 hours, P = 0.006) and more rapid resumption of oral diet (24 vs. 72 hours, P = 0.017); and a shorter postoperative hospital stay (3 vs. 10 days, P < 0.0001).
The laparoscopic approach to splenectomy for massive splenomegaly is feasible and safe. Despite a longer operating time, the postoperative recovery following laparoscopic splenectomy is smoother, with lower morbidity and shorter postoperative hospital stay compared with open splenectomy.
尽管腹腔镜脾切除术有诸多益处，但其在巨脾（脾脏重量≥1000克）患者中的应用仍存在争议。在本研究中，我们评估了与开放性脾切除术相比，腹腔镜脾切除术治疗巨脾的安全性和可行性。
由一位外科医生对所有巨脾患者采用腹腔镜脾切除术，而其他外科医生则通过剖腹手术进行。两种手术方式的结果基于意向性分析进行比较。连续变量的结果以中位数表示。
2000年至2005年期间，15例患者接受了腹腔镜脾切除术，1996年至2003年期间，13例患者接受了开放性脾切除术。两组在年龄、性别、美国麻醉医师协会评分和脾脏重量（1.3千克对1.1千克）方面具有可比性。有1例（6.6%）转为开放性手术。尽管腹腔镜脾切除术的手术时间显著更长（175分钟对90分钟，P<0.001），但其术后发病率和死亡率更低（分别为13.3%对30.8%和0对7.7%）。腹腔镜脾切除术的吗啡等效总剂量（29毫克对264毫克，P<0.0001）和阿片类药物使用时间（1天对4天，P<0.0001）显著更低；胃肠外补液时间（24小时对96小时，P = 0.006）以及恢复经口饮食更快（24小时对72小时，P = 0.017）；术后住院时间更短（3天对10天，P<0.0001）。
腹腔镜脾切除术治疗巨脾是可行且安全的。尽管手术时间较长，但与开放性脾切除术相比，腹腔镜脾切除术后的恢复更顺利，发病率更低，术后住院时间更短。
