活体肝移植术后患者手辅助腹腔镜脾切除术治疗脾功能亢进的可行性及有效性
The feasibility and effectiveness of a hand-assisted laparoscopic splenectomy for hypersplenism in patients after living-donor liver transplantation.
作者信息
Uehara Hideo, Kawanaka Hirofumi, Akahoshi Tomohiko, Tomikawa Morimasa, Kinjo Nao, Hashimoto Naotaka, Ikegami Toru, Soejima Yuuji, Taketomi Akinobu, Maehara Yoshihiko
机构信息
Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
出版信息
Surg Laparosc Endosc Percutan Tech. 2009 Dec;19(6):484-7. doi: 10.1097/SLE.0b013e3181bc3f90.
BACKGROUND
A laparoscopic splenectomy in patients who previously underwent living-donor liver transplantation (LDLT) is thought to be technically difficult because of the presence of severe adhesions and splenomegaly. This report documents the efficacy and safety of a hand-assisted laparoscopic splenectomy (HALS) for hypersplenism in patients after LDLT.
METHODS
Five patients underwent HALS for hypersplenism after LDLT between 1999 and 2007. The medical records of those patients were retrospectively evaluated.
RESULTS
The mean operative time was 237+/-12 minutes. The mean blood loss was 229+/-100 mL and the mean weight of excised spleen was 461+/-46 g. There was no conversion to open surgery. The number of platelets and leukocytes were significantly increased after surgery. No major complications were observed except for a patient who suffered paralytic ileus postoperatively. The mean hospital stay after the operation was 16.7+/-2.5 days.
CONCLUSIONS
HALS for patients after LDLT is a feasible and safe procedure. This technique can thus become a standard procedure after LDLT.
背景
由于存在严重粘连和脾肿大，既往接受活体肝移植（LDLT）的患者行腹腔镜脾切除术被认为技术难度较大。本报告记录了手辅助腹腔镜脾切除术（HALS）治疗LDLT术后脾功能亢进患者的有效性和安全性。
方法
1999年至2007年间，5例LDLT术后脾功能亢进患者接受了HALS。对这些患者的病历进行了回顾性评估。
结果
平均手术时间为237±12分钟。平均失血量为229±100毫升，切除脾脏的平均重量为461±46克。无中转开腹手术。术后血小板和白细胞数量显著增加。除1例术后发生麻痹性肠梗阻的患者外，未观察到重大并发症。术后平均住院时间为16.7±2.5天。
结论
LDLT术后患者行HALS是一种可行且安全的手术。因此，该技术可成为LDLT术后的标准手术。
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