Kawanaka Hirofumi, Akahoshi Tomohiko, Kinjo Nao, Konishi Kozou, Yoshida Daisuke, Anegawa Go, Yamaguchi Shohei, Uehara Hideo, Hashimoto Naotaka, Tsutsumi Norifumi, Tomikawa Morimasa, Koushi Kenichi, Harada Noboru, Ikeda Yasuharu, Korenaga Daisuke, Takenaka Kenji, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(6):749-57. doi: 10.1007/s00534-009-0149-8. Epub 2009 Jul 22.
BACKGROUND/PURPOSE: The aims of this study were to standardize the techniques of laparoscopic splenectomy (LS) to improve safety in liver cirrhosis patients with portal hypertension.
From 1993 to 2008, 265 cirrhotic patients underwent LS. Child-Pugh class was A in 112 patients, B in 124, and C in 29. Since January 2005, we have adopted the standardized LS including the following three points: hand-assisted laparoscopic surgery (HALS) should be performed in patients with splenomegaly (> or =1,000 mL), perisplenic collateral vessels, or Child-Pugh score 9 or more; complete division and sufficient elevation of the upper pole of the spleen should be performed before the splenic hilar division; and when surgeons feel the division of the upper pole of the spleen is too difficult, conversion to HALS should be performed.
There were no deaths related to LS in this study. After the standardization, conversion to open surgery significantly reduced from 11 (10.3%) of 106 to 3 (1.9%) of 159 patients (P < 0.05). The average operation time and blood loss significantly reduced from 259 to 234 min (P < 0.01) and from 506 to 171 g (P < 0.01), respectively.
With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.
背景/目的：本研究旨在规范腹腔镜脾切除术（LS）技术，以提高门静脉高压肝硬化患者的手术安全性。
1993年至2008年，265例肝硬化患者接受了LS。其中Child-Pugh A级112例，B级124例，C级29例。自2005年1月起，我们采用了标准化的LS，包括以下三点：对于脾肿大（≥1000 mL）、脾周侧支血管或Child-Pugh评分9分及以上的患者，应采用手辅助腹腔镜手术（HALS）；在脾门离断前，应完整离断并充分上提脾上极；当术者感觉脾上极离断困难时，应转为HALS。
本研究中无与LS相关的死亡病例。标准化后，转为开腹手术的比例从106例中的11例（10.3%）显著降至159例中的3例（1.9%）（P<0.05）。平均手术时间和失血量分别从259分钟显著降至234分钟（P<0.01），从506克降至171克（P<0.01）。
通过技术标准化，LS成为肝硬化和门静脉高压患者可行且安全的手术方法。
