Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA.
World J Surg. 2013 Jan;37(1):52-8. doi: 10.1007/s00268-012-1789-4.
The aim of this study was to determine the predictive value of the preoperative three-dimensional reconstructed volume (3D volumetry) for outcomes of laparoscopic splenectomy. The impact of splenomegaly on the feasibility of laparoscopic splenectomy is still debated. We hypothesized that splenic volumetry may accurately estimate splenic volume preoperatively and be used by surgeons to select patients for laparoscopic splenectomy.
We performed a retrospective review of 88 patients seen at a tertiary referral center undergoing laparoscopic or open splenectomy between 2001 and 2010. Patients included in the study underwent elective splenectomy without associated procedures and had preoperative imaging available at our institution. We evaluated clinical, demographic characteristics and perioperative imaging as predictors of outcome. Study endpoints included conversion to open splenectomy, operating time, estimated blood loss (EBL), length of stay (LOS), postoperative complications, and mortality.
In all, 53 procedures were started laparoscopically. Among them, 7 (13.2 %) were converted to open splenectomy and 7 (13.2 %) to hand-assisted laparoscopic splenectomy. The conversion group was matched with 35 patients who underwent open splenectomy to determine differences in outcomes between these groups. There were no conversions in spleens measuring <1100 cc, whereas spleens of 1100 to 2700 cc had a conversion rate of 41 %. Spleen volume >2700 cc was associated with an 87.5 % conversion rate. Spleen 3D volumetry >2700 cc was the only independent predictor of surgical conversion on multivariate analysis (odds ratio 38.0, confidence interval 4.02-358.75, p = 0.001). Patients who underwent open splenectomy had shorter operating times (160.3 vs. 253.0 min, p = 0.001) than those converted from laparoscopic to open splenectomy.
A 3D reconstructed splenic volume of >2700 cc is a predictor of conversion from laparoscopic to open splenectomy. For spleens measuring <2700 cc, laparoscopic splenectomy may be performed by experienced surgeons with low to moderate rates of conversion. For spleens with a 3D reconstructed volume >2700 cc, laparoscopic splenectomy is associated with high rates of conversion to open surgery.
本研究旨在确定术前三维重建体积（3D 容积测量）对腹腔镜脾切除术结果的预测价值。脾肿大对腹腔镜脾切除术可行性的影响仍存在争议。我们假设脾容积测量可能在术前准确估计脾脏体积，并由外科医生用于选择腹腔镜脾切除术患者。
我们对 2001 年至 2010 年间在三级转诊中心接受腹腔镜或开放性脾切除术的 88 例患者进行了回顾性研究。本研究纳入的患者接受了择期脾切除术，无相关手术，且在我院术前影像学检查。我们评估了临床、人口统计学特征和围手术期影像学作为结果的预测因素。研究终点包括转为开放性脾切除术、手术时间、估计失血量（EBL）、住院时间（LOS）、术后并发症和死亡率。
总共进行了 53 例腹腔镜手术。其中 7 例（13.2%）转为开放性脾切除术，7 例（13.2%）转为手助腹腔镜脾切除术。转换组与 35 例接受开放性脾切除术的患者进行了匹配，以确定两组之间的结果差异。脾脏体积<1100cc 时无转换，脾脏体积 1100-2700cc 时转换率为 41%。脾脏体积>2700cc 与 87.5%的转换率相关。脾脏 3D 容积测量>2700cc 是多变量分析中手术转换的唯一独立预测因素（比值比 38.0，置信区间 4.02-358.75，p=0.001）。与腹腔镜转为开放性脾切除术的患者相比，接受开放性脾切除术的患者手术时间更短（160.3 分钟 vs. 253.0 分钟，p=0.001）。
3D 重建脾脏体积>2700cc 是从腹腔镜转为开放性脾切除术的预测因素。对于体积<2700cc 的脾脏，经验丰富的外科医生可以进行腹腔镜脾切除术，其转换率较低或中等。对于 3D 重建体积>2700cc 的脾脏，腹腔镜脾切除术与高转化率转为开放性手术相关。
