Hyodo M, Sata N, Koizumi M, Sakuma Y, Kurihara K, Lefor A T, Ohki J, Nagai H, Yasuda Y
Department of Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
Asian J Endosc Surg. 2012 May;5(2):63-8. doi: 10.1111/j.1758-5910.2011.00124.x. Epub 2011 Dec 30.
Laparoscopic splenectomy using pneumoperitoneum has been performed since 1992. The gasless abdominal wall-lifting method for laparoscopic splenectomy was introduced as an alternative. This retrospective study was undertaken to compare results using the two techniques.
Between 1995 and 2010, 54 patients underwent laparoscopic splenectomy at a single institution; 30 underwent the procedure using the gasless technique and 24 using pneumoperitoneum. There were no significant differences between the two groups regarding age, sex or BMI, but more patients underwent concurrent operations in the pneumoperitoneum group. The abdominal wall-lift system with subcutaneous K-wires was used for the gasless method.
Intraoperative blood loss was similar in the two groups (193.0 ± 196.7 mL gasless, 217.3 ± 296.6 mL pneumoperitoneum; P > 0.05), but operative time (182.1 ± 92.1 min, 135.1 ± 46.1 min; P < 0.05), and resected spleen weight (306.1 ± 297.7 g, 138 ± 81.0 g; P < 0.05) were significantly different. In the gasless group, additional procedures included conversion (n = 1), mini-laparotomy (n = 2), and CO(2) insufflation (n = 2). Excluding the concurrent living-related kidney donor patients, hospital stay was similar (6.9 ± 2.5 days, 6.3 ± 2.0 days, P > 0.05).
Although gasless laparoscopic splenectomy is feasible, there are disadvantages, particularly the restricted operative working space in some patients. These results suggest that either technique may be used on an individual basis in patients undergoing laparoscopic splenectomy.
自1992年起便开始实施使用气腹的腹腔镜脾切除术。作为一种替代方法，无气腹壁提升法被引入用于腹腔镜脾切除术。本回顾性研究旨在比较这两种技术的效果。
1995年至2010年间，54例患者在同一机构接受了腹腔镜脾切除术；30例采用无气技术进行手术，24例采用气腹法。两组在年龄、性别或体重指数方面无显著差异，但气腹组中有更多患者同时进行了其他手术。无气法使用带有皮下克氏针的腹壁提升系统。
两组术中失血量相似（无气组193.0±196.7 mL，气腹组217.3±296.6 mL；P>0.05），但手术时间（182.1±92.1分钟，135.1±46.1分钟；P<0.05）和切除脾脏重量（306.1±297.7 g，138±81.0 g；P<0.05）有显著差异。在无气组中，额外的操作包括中转开腹（n = 1）、迷你剖腹术（n = 2）和二氧化碳气腹（n = 2）。排除同时进行活体亲属供肾手术的患者后，住院时间相似（6.9±2.5天，6.3±2.0天，P>0.05）。
尽管无气腹腔镜脾切除术是可行的，但存在一些缺点，特别是在某些患者中手术操作空间受限。这些结果表明，在接受腹腔镜脾切除术的患者中，两种技术均可根据个体情况使用。
