Nobili Cinzia, Romano Fabrizio, Ciravegna Arianna Libera, Garancini Mattia, Degrate Luca, Uggeri Fabio, Uggeri Franco
Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy.
J Laparoendosc Adv Surg Tech A. 2011 May;21(4):313-7. doi: 10.1089/lap.2010.0442. Epub 2011 Mar 2.
With recent advancements in the field of minimally invasive surgery, combined laparoscopic procedure is now being performed for treating coexisting abdominal pathologies during the same surgery. In some patients, spleen disorders are associated with gallbladder stones. Conventional surgery requires a wide upper abdominal incision for correct exposure of both organs. The aim of this study was to assess the feasibility and outcomes of concomitant laparoscopic treatment for coexisting spleen and gallbladder diseases.
Thirty consecutive laparoscopic splenectomy (LS) plus laparoscopic cholecystectomy (LC) have been performed in our department between January 2000 and December 2009 (24% of 125 LS performed in this period). There were 11 female patients and 19 male patients, with a median age of 16.2 years (range: 4-55). Indications were hereditary spherocytosis for 22 cases, idiopathic thrombocytopenic purpura for 3 cases, thalassemia for 4 cases, and sickle cell disease for 1 case. Patients were operated on using right semilateral position, tilting the table from right to left, using a five-trocar technique in 25 cases and a four-trocar technique in the last 5 cases. Cholecystectomy was performed first, then splenectomy was achieved, and spleen was removed in an Endobag.
One patient required conversion to open procedure (3.3%) because of splenomegaly. Average operative time was 150 minutes (range: 90-240). Average length of stay was 3.5 days (range: 3-11). Mean blood loss was 60 mL (range: 30-500). Transfusion rate was 3.3%. Mean spleen size and weight were, respectively, 16.5 cm and 410 g. No perioperative mortality occurred in the series. We reported 3 cases of hemoperitoneum, of which one managed conservatively. The results using four trocars were comparable to those with five trocars.
With increasing institutional experience, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases. The four-trocar technique guarantees good results.
随着微创手术领域的最新进展，现在可以在同一手术中采用联合腹腔镜手术治疗并存的腹部病变。在一些患者中，脾脏疾病与胆结石相关。传统手术需要在上腹部做一个大切口，以便正确暴露两个器官。本研究的目的是评估同期腹腔镜治疗并存的脾脏和胆囊疾病的可行性及疗效。
2000年1月至2009年12月期间，我科连续进行了30例腹腔镜脾切除术（LS）加腹腔镜胆囊切除术（LC）（占同期125例LS的24%）。其中女性患者11例，男性患者19例，中位年龄为16.2岁（范围：4 - 55岁）。手术指征为遗传性球形红细胞增多症22例、特发性血小板减少性紫癜3例、地中海贫血4例、镰状细胞病1例。患者采用右侧半卧位，手术台从右向左倾斜，25例采用五孔技术，最后5例采用四孔技术。先进行胆囊切除术，然后进行脾切除术，脾脏装入Endobag取出。
1例患者因脾肿大转为开放手术（3.3%）。平均手术时间为150分钟（范围：90 - 240分钟）。平均住院时间为3.5天（范围：3 - 11天）。平均失血量为60毫升（范围：30 - 500毫升）。输血率为3.3%。脾脏平均大小和重量分别为16.5厘米和410克。该系列中无围手术期死亡病例。我们报告了3例腹腔内出血，其中1例保守治疗。四孔技术的结果与五孔技术相当。
随着机构经验的增加，同期腹腔镜脾切除术和胆囊切除术是一种安全可行的手术，对于并存的脾脏和胆囊疾病可以考虑采用。四孔技术可保证良好效果。
