Department of Laparoscopic and Robotic Surgery, Azienda Ospedaliera dei Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, NA, Italy.
Surg Endosc. 2012 Oct;26(10):2870-6. doi: 10.1007/s00464-012-2272-x. Epub 2012 May 12.
Laparoscopic splenectomy (LS) has gradually become the technique of choice for surgical removal of the spleen. The aim of this study was to evaluate the efficacy of LS in a large cohort of patients from a single center.
From March 1992 to June 2010, 300 patients underwent LS at our hospital for predominantly hematologic disorders. The first 92 cases were performed using an anterior approach, whereas in the remaining 208 cases a lateral approach with a four-trocar technique was used. Patient demographics, diagnosis, and outcomes were reviewed.
Spleen volume was similar between the anterior (350 ml) and the lateral (370 ml) approaches. The lateral approach was associated with shorter operative time (60 vs. 80 min), less blood loss (30 vs. 110 ml), and no conversion (0 vs. 2.2 %) compared to the anterior approach. Reoperations were required in three patients (1.0 %) because of bleeding, subphrenic abscess, and intestinal ischemia. Postoperative complications were significantly fewer for the lateral (4.8 %) than for the anterior (31.5 %) approach and the hospital stay was shorter (3.1 vs. 5.2 days) and there was less postoperative pain. Splenectomy for hematologic malignancies resulted in a higher morbidity rate, more postoperative pain, and longer hospital stay. Overall mortality rate was 0.3 %. No late complications were observed during the 1-5-year follow-up.
LS using the lateral approach with the placement of four trocars can be considered the procedure of choice for both benign and malignant diseases affecting the spleen. Extensive experience and technical standardization help to avoid surgical pitfalls, providing an adequate control of hemostasis, the excision of accessory spleens (AS), and the avoidance of parenchymal rupture.
腹腔镜脾切除术（LS）已逐渐成为脾切除的首选手术方法。本研究旨在评估单中心大样本患者 LS 的疗效。
1992 年 3 月至 2010 年 6 月，我院对 300 例主要血液病患者行 LS。前 92 例采用前入路，后 208 例采用外侧入路四孔法。回顾患者的人口统计学、诊断和结果。
前入路（350ml）与外侧入路（370ml）的脾脏体积相似。与前入路相比，外侧入路的手术时间更短（60 分钟 vs. 80 分钟），出血量更少（30 毫升 vs. 110 毫升），无中转开腹（0% vs. 2.2%）。因出血、膈下脓肿和肠缺血，3 例（1.0%）患者需再次手术。术后并发症外侧入路组（4.8%）显著少于前入路组（31.5%），住院时间更短（3.1 天 vs. 5.2 天），术后疼痛较轻。脾恶性肿瘤患者的发病率、术后疼痛和住院时间更高。总死亡率为 0.3%。1-5 年随访期间无迟发性并发症。
采用外侧入路四孔法 LS 可作为治疗脾良恶性疾病的首选方法。广泛的经验和技术标准化有助于避免手术陷阱，充分控制止血、切除副脾（AS）并避免实质破裂。
