手辅助腹腔镜脾切除术治疗脾肿大：与传统腹腔镜脾切除术的比较研究

Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy.

作者信息

Wang Ke-Xin, Hu San-Yuan, Zhang Guang-Yong, Chen Bo, Zhang Hai-Feng

机构信息

Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China.

出版信息

Chin Med J (Engl). 2007 Jan 5;120(1):41-5.

PMID:17254486

Abstract

BACKGROUND

Laparoscopic splenectomy (LS) has been considered as the standard approach to remove a normal-sized spleen, but it is facing technical challenges when applied to splenomegaly. Hand-assisted laparoscopic technique was designed to facilitate the performance of difficult laparoscopic procedure. This study was aimed to evaluate the efficacy and superiority of hand-assisted laparoscopic splenectomy (HALS) for splenomegaly.

METHODS

From November 1994 to January 2006, 36 patients with splenomegaly (final spleen weight > 700 g) were treated with laparoscopic operations for splenectomy in our hospital. Conventional LS was performed in 16 patients (7 men and 9 women, group 1) and HALS in the other 20 patients (12 men and 8 women, group 2). The patients' features, intraoperative details and the postoperative outcomes in the both groups were compared.

RESULTS

The both groups were comparable in the terms of patient's age ((38 +/- 12) years vs (43 +/- 14)years, P > 0.05), the greatest splenic diameter ((24 +/- 5)cm vs (27 +/- 7)cm, P > 0.05), preoperative platelet count ((118 +/- 94) x 10(9)/L vs (97 +/- 81) x 10(9)/L, P > 0.05) and diagnosis. Compared with LS group, operation time ((195 +/- 71) minutes vs (141 +/- 64) minutes, P < 0.05) was shorter, intraoperative blood loss ((138 +/- 80)ml vs (86 +/- 45)ml, P < 0.05) and conversion rate (4/16 vs 0/20, P < 0.05) were lower, but hospital stay ((5.3 +/- 3.8) days vs (7.4 +/- 1.6) days, P < 0.05) was longer in HALS group. There was no significant difference in the aspects of intraoperative and postoperative complication rate (2/16 vs 0/20, P > 0.05) or recovery time of gastrointestinal function ((16.3 +/- 11.6) hours vs (18.7 +/- 8.1) hours, P > 0.05) between the two groups.

CONCLUSIONS

In the cases of splenomegaly, HALS significantly facilitates the surgical procedure and reduces the operational risk, while maintaining the advantages of conventional LS. HALS is more feasible and more effective than conventional LS for the removal of splenomegaly.

摘要

背景

腹腔镜脾切除术（LS）一直被视为切除正常大小脾脏的标准方法，但应用于脾肿大时面临技术挑战。手辅助腹腔镜技术旨在便于进行困难的腹腔镜手术。本研究旨在评估手辅助腹腔镜脾切除术（HALS）治疗脾肿大的疗效和优势。

方法

1994年11月至2006年1月，我院对36例脾肿大患者（最终脾脏重量>700g）行腹腔镜脾切除手术。16例患者（7例男性，9例女性，第1组）行传统LS，另外20例患者（12例男性，8例女性，第2组）行HALS。比较两组患者的特征、术中细节及术后结果。

结果

两组患者在年龄（（38±12）岁 vs （43±14）岁，P>0.05）、脾脏最大直径（（24±5）cm vs （27±7）cm，P>0.05）、术前血小板计数（（１１８±９４）×１０⁹/L vs （９７±８１）×１０⁹/L，P>0.05）及诊断方面具有可比性。与LS组相比，HALS组手术时间（（195±71）分钟 vs （141±64）分钟，P<0.05）更短，术中出血量（（138±80）ml vs （86±45）ml，P<0.05）和中转率（4/16 vs 0/20，P<0.05）更低，但住院时间（（5.3±3.8）天 vs （7.4±1.6）天，P<0.05）更长。两组在术中和术后并发症发生率（2/16 vs 0/20，P>0.05）或胃肠功能恢复时间（（16.3±11.6）小时 vs （18.7±8.1）小时，P>0.05）方面无显著差异。