Sotomayor-Ramírez Ramón K
Department of Surgery, Hospital Interamericano de Medicina Avanzada, Caguas, Puerto Rico 00725.
Bol Asoc Med P R. 2009 Apr-Jun;101(2):43-9.
Laparoscopic splenectomy has advantages over conventional surgery mainly related to the smaller incision, less postoperative pain and shorter recovery period. The aim of this study was to assess the outcomes of patients with diseases of the spleen managed by elective laparoscopic splenectomy.
Retrospective review of medical charts was performed of patients who underwent laparoscopic splenectomy by a single surgeon during a three year period. Patient demographics, diagnosis and outcomes including operative time, weight of the specimens, blood loss, operative complications, length of stay, and long term outcome with platelet counts in Immune Thrombocytopenic Purpura (ITP) were reviewed. Data on the presence of an accessory spleens, and need for use of hand assist devices was reviewed.
Fourteen patients underwent laparoscopic splenectomy; 9 (nine) for Immune Thrombocytopenic Purpura(ITP); one for Evans Syndrome, one for splenic artery aneurysm, two for suspected lymphoma and one for suspected metastatic disease. Ages were 22 to 70 years (mean 46.6). All patients underwent surgery in a full lateral position. Eight specimens were morcellated for removal and 6 were removed intact; 4 using a hand assist device and two by extending one of the port incisions. In 10 patients, total laparoscopic splenectomy was completed; four patients required use of a hand assist device due to difficulty with the operation. Mean spleen weight was 127 gms; spleen weight for ITP specimens was 90 gms; for non ITP diagnosis mean weight was 230 gms. Accessory spleens were identified and excised in two patients. Mean operative time for all patients was 137 minutes. Mean operative blood loss was 202 ml; no patients were transfused as a result of perioperative bleeding. Time to start diet was from 1-2 days and length of stay was 2.9 days. Two patients had post op fevers requiring prolonged length of stay. There were two readmission for deep venous thrombosis, and one for brain toxoplasmosis six weeks post op. Two ITP patients older than 40 years relapsed during the first year.
Laparoscopic splenectomy can be safely performed using the lateral approach with a high success rate, low rate of blood loss and a low rate of perioperative complications. Laparoscopic splenectomy should be offered to all patients undergoing surgery for ITP. Use of hand assist devices can facilitate surgery for larger spleens and avoid need of conversion to open surgery. Accessory spleens can be adequately identified and excised using laparoscopic splenectomy. Hematologic response in ITP is adequate with laparoscopic splenectomy.
腹腔镜脾切除术相较于传统手术具有优势，主要体现在切口更小、术后疼痛减轻以及恢复时间缩短。本研究的目的是评估择期腹腔镜脾切除术治疗脾脏疾病患者的疗效。
对一位外科医生在三年期间实施腹腔镜脾切除术的患者病历进行回顾性分析。回顾了患者的人口统计学资料、诊断及结局，包括手术时间、标本重量、失血量、手术并发症、住院时间以及免疫性血小板减少性紫癜（ITP）患者的血小板计数长期结局。还回顾了副脾的存在情况以及使用手辅助装置的必要性数据。
14例患者接受了腹腔镜脾切除术；9例因免疫性血小板减少性紫癜（ITP）；1例因伊文氏综合征，1例因脾动脉瘤，2例因疑似淋巴瘤，1例因疑似转移性疾病。年龄为22至70岁（平均46.6岁）。所有患者均采取完全侧卧位进行手术。8个标本被切碎取出，6个完整取出；4个使用手辅助装置，2个通过扩大一个端口切口取出。10例患者完成了全腹腔镜脾切除术；4例患者因手术困难需要使用手辅助装置。脾脏平均重量为127克；ITP标本的脾脏重量为90克；非ITP诊断的平均重量为230克。2例患者发现并切除了副脾。所有患者的平均手术时间为137分钟。平均手术失血量为202毫升；没有患者因围手术期出血而输血。开始进食时间为1至2天，住院时间为2.9天。2例患者术后发热，住院时间延长。有2例因深静脉血栓再次入院，1例在术后六周因脑弓形虫病再次入院。2例年龄大于40岁的ITP患者在第一年复发。
采用侧卧位可安全地实施腹腔镜脾切除术，成功率高、失血量少且围手术期并发症发生率低。所有接受ITP手术的患者均应考虑腹腔镜脾切除术。使用手辅助装置有助于较大脾脏的手术，避免转为开放手术。使用腹腔镜脾切除术可充分识别并切除副脾。腹腔镜脾切除术对ITP的血液学反应良好。
