Palanivelu Chinnasamy, Jani Kalpesh, Malladi Vijaykumar, Shetty Roshan, Senthilkumar Rangasamy, Maheshkumar Gobi
Gem Hospital, Coimbatore, Tamil Nadu, India.
J Laparoendosc Adv Surg Tech A. 2006 Aug;16(4):339-44. doi: 10.1089/lap.2006.16.339.
A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery.
Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen.
The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years).
In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy.
对于腹腔镜脾切除术，已经提出了多种方法，包括前入路、外侧入路（吊脾技术）和半外侧入路（倾脾技术）。我们提倡采用倾脾入路并早期结扎脾动脉。
自1997年以来，我们采用倾脾入路并早期结扎脾动脉进行了120例腹腔镜脾切除术。患者取70度半右侧卧位。手术步骤为：显露小网膜囊、控制脾动脉、游离脾曲、切断脾结肠韧带、切断脾肾韧带、游离脾门、游离脾上极以及切除标本。
最常见的手术适应证是自身免疫性溶血性贫血（35.8%）。1例患者患有严重的脾周炎，粘连广泛且血管丰富，导致手术中渗血，使腹腔镜视野模糊，需要转为开放手术。影像学检查显示脾脏平均直径为22.8 cm（范围为12.5 - 37.0 cm）。平均手术时间为85分钟（范围为54 - 124分钟）。8.3%的患者同时进行了腹腔镜胆囊切除术以治疗色素性胆结石。发现副脾组织的患者占4.2%。平均住院时间为3天（范围为1 - 6天）。术后无明显并发症。平均随访时间为5.4年（范围为1个月 - 9年）。
在倾脾入路中采用早期结扎脾动脉的改良方法，我们认为有助于推进腹腔镜脾切除术。
