Xu Wei-li, Li Suo-lin, Wang Yan, Shi Bao-jun, Li Meng, Li Ying-chao, Zhong Zhi-yong, Li Zhen-dong
Department of Pediatric Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Chin Med J (Engl). 2009 May 20;122(10):1203-8.
Laparoscopic splenectomy (LS) is currently the standard approach for resection of a normal-sized spleen. However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging (CDFI) in splenic vessel anatomy and evaluated its value for LS.
Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size (CDFI group). In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed (non-CDFI group). Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student's t test.
All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the constituent ratios of the parameters by CDFI and those by intraoperative telerecording in the CDFI group (chi(2) = 0.383, 1.072, 0.119, P = 0.536, 0.784, 0.730). However, statistically significant differences were observed in the operative time ((158.70 +/- 42.51) minutes vs (200.65 +/- 47.89) minutes, P = 0.003), intraoperative blood loss ((55.87 +/- 17.36) ml vs (101.83 +/- 62.21) ml, P = 0.001), and recovery time of gastrointestinal function ((24.39 +/- 8.88) hours vs (30.60 +/- 9.45) hours, P = 0.024) between the groups.
The individual operative route and schedule can be successfully determined on the basis of various kinds of reproducible anatomic frameworks of the spleen provided by preoperative CDFI. This technique facilitates the surgical procedure, shortens the operative time, reduces intraoperative blood loss and decreases the risk of LS in splenomegaly cases.
腹腔镜脾切除术（LS）是目前切除正常大小脾脏的标准方法。然而，在脾肿大的情况下，由于术中出血，这种方法会成为技术挑战。全面了解脾血管解剖结构对于顺利完成困难的腹腔镜手术很重要。在这项回顾性研究中，我们研究了彩色多普勒血流成像（CDFI）在脾血管解剖中的作用，并评估了其在腹腔镜脾切除术中的价值。
2004年5月至2007年12月期间因各种血液系统和自身免疫性疾病接受脾切除术的48例患者纳入本研究。23例患者接受了术前CDFI检查，包括脾蒂解剖类型、脾血管与胰腺的毗邻关系以及脾脏大小检查（CDFI组）。其余25例患者未进行脾血管超声检查（非CDFI组）。CDFI组的腹腔镜脾切除术根据每位患者术前CDFI提供的信息进行。非CDFI组则按照传统方法进行LS。在CDFI组中，使用卡方检验比较CDFI上述参数的构成比与LS术中记录的参数构成比。两组手术技术的有效性采用独立样本t检验进行比较。
两组所有腹腔镜脾切除术均成功完成。然而，非CDFI组有2例因脾静脉分支被意外撕裂，在微型切口辅助下转为开腹脾切除术。CDFI检测到两种脾蒂解剖类型以及脾血管与胰腺之间四种不同的毗邻关系。约80%的脾脏符合巨脾标准。CDFI组中CDFI参数构成比与术中远程记录的参数构成比之间无统计学显著差异（χ² = 0.383、1.072、0.119，P = 0.536、0.784、0.730）。然而，两组在手术时间（（158.70 ± 42.51）分钟 vs （200.65 ± 47.89）分钟，P = 0.003）、术中出血量（（55.87 ± 17.36）ml vs （101.83 ± 62.21）ml，P = 0.001）和胃肠功能恢复时间（（24.39 ± 8. .88）小时 vs （30.60 ± 9.45）小时，P = 0.024）方面存在统计学显著差异。
基于术前CDFI提供的各种可重复的脾脏解剖框架，可以成功确定个体手术路径和方案。该技术有助于手术操作，缩短手术时间，减少术中出血，并降低脾肿大病例中LS的风险。
