Department of Surgery, Morristown Memorial Hospital-Atlantic Health, Morristown, NJ, USA.
Am J Surg. 2012 Apr;203(4):517-22. doi: 10.1016/j.amjsurg.2011.05.014. Epub 2011 Sep 14.
Massive and supramassive splenomegaly are relative contraindications to pure laparoscopic splenectomy (LS).
A retrospective review of adult patients was conducted for splenectomy occurring from 1999 to 2009. Massive and supramassive spleens were defined as craniocaudad length ≥ 17 cm or weight ≥ 600 g and craniocaudad length ≥ 22 cm or weight ≥ 1,600 g, respectively.
LS was done for 22 and open splenectomy for 21 patients, of which 12 and 14 were supramassive. Spleen weight and craniocaudad length were comparable. LS was associated with lower blood loss (308 vs 400 mL, P = .24), shorter length of stay (3 vs 4.5 days, P = .054), and similar morbidity (17% vs 14%). Two reoperations and 1 death occurred with open splenectomy. Operative times were longer for LS (195 vs 105 min, P = .008), while the conversion rate was 25%.
In cases of massive and supramassive splenomegaly, better outcomes are accomplished with LS than open splenectomy, and are comparable to hand-assisted LS.
巨大和超巨大脾肿大是纯腹腔镜脾切除术（LS）的相对禁忌症。
对 1999 年至 2009 年期间进行的脾切除术患者进行回顾性分析。巨大脾和超巨大脾分别定义为前后径≥17cm或重量≥600g和前后径≥22cm或重量≥1600g。
LS 用于 22 例，开放性脾切除术用于 21 例，其中 12 例和 14 例为超巨大脾。脾重和前后径相当。LS 组出血量较少（308 比 400 毫升，P=0.24），住院时间较短（3 比 4.5 天，P=0.054），发病率相似（17%比 14%）。开放性脾切除术有 2 例再次手术和 1 例死亡。LS 的手术时间较长（195 比 105 分钟，P=0.008），但转化率为 25%。
对于巨大和超巨大脾肿大，LS 比开放性脾切除术的效果更好，与手助 LS 相当。
