Carlini Massimo, Giovannini Cristiano, Castaldi Fabio, Cianciulli Paolo, Sorrentino Francesco, Mercadante Edoardo
U.O.C. Chirurgia Generale, Ospedale S. Eugenio, Roma.
Chir Ital. 2009 Jul-Aug;61(4):427-33.
In 1991 Delaitre and Maignien described the first laparoscopic splenectomy, since when a rapid spread of this technique has been observed and the procedure has become the gold standard in the surgical management of benign and malignant haematological diseases. In the present study, the results of the first 30 laparoscopic splenectomies performed at the Division of General Surgery of the S. Eugenio Hospital of Rome are reported. The operations were performed in patients with benign (27 cases) and malignant (3 cases) haematological diseases, treated in the Regional Haematological Centre of the same hospital. The procedures were carried out according to criteria corresponding to those recently described in the guidelines of the European Association for Endoscopic Surgery. As regards the results, two procedures (6.7%) were converted to open surgery. One postoperative haemorrhage was observed, requiring a laparoscopic reoperation for haemostasis. No other major local or general complications were observed. Mortality was nil. The mean postoperative hospital stay was 4.2 days (range: 4-8 days). Medium-term surgical and haematological results were excellent. Laparoscopic splenectomy is the surgical gold standard, but should be performed in advanced centres in close cooperation with a haematology centre. The procedure is indicated in all patients who are candidates for splenectomy, with the sole exception of those affected by portal hypertension or with general contraindications to laparoscopy. In advanced centres, better early and late results can be achieved, in addition to the well-known benefits of the minimally invasive technique, particularly in aesthetic terms, which in younger patients affected by benign haematological pathologies are very important.
1991年，德莱特尔和迈尼安描述了首例腹腔镜脾切除术，自那时起，该技术迅速普及，已成为良性和恶性血液系统疾病外科治疗的金标准。在本研究中，报告了罗马圣欧金尼奥医院普通外科完成的首例30例腹腔镜脾切除术的结果。手术对象为患有良性（27例）和恶性（3例）血液系统疾病的患者，这些患者在同一家医院的地区血液中心接受治疗。手术按照与欧洲内镜外科学会指南中最近描述的标准进行。至于结果，有两例手术（6.7%）转为开放手术。观察到1例术后出血，需要进行腹腔镜再次手术止血。未观察到其他严重的局部或全身并发症。死亡率为零。术后平均住院时间为4.2天（范围：4 - 8天）。中期手术和血液学结果良好。腹腔镜脾切除术是外科金标准，但应在先进中心与血液学中心密切合作下进行。该手术适用于所有适合脾切除术的患者，唯一例外是患有门静脉高压或有腹腔镜手术一般禁忌证的患者。在先进中心，除了微创技术的众所周知的益处，特别是在美学方面，对受良性血液系统疾病影响的年轻患者非常重要外，还可取得更好的早期和晚期结果。
