Chen Xiao-Dong, He Fu-Qian, Yang Lie, Yu Yong-Yang, Zhou Zong-Guang
Department of Hepatobiliary-Gastrointestinal Surgery, Sichuan Cancer Hospital and Institute, Chengdu, China.
ANZ J Surg. 2013 Mar;83(3):122-8. doi: 10.1111/ans.12003. Epub 2012 Nov 22.
Open splenectomy and devascularization are effective treatments for cirrhotic patients with severe thrombocytopenia and variceal bleeding. However, it remains controversial whether laparoscopic splenectomy (LS) and devascularization (LSD) can be indicated and beneficial in these patients.
A systematic review of the efficacy and safety of LS and LSD for patients with liver cirrhosis and portal hypertension was undertaken to clarify controversy about their utilization in such patients.
A systematic search strategy was performed to retrieve relevant studies from PubMed and Embase.com. The literature search and data extraction were independently performed by two reviewers.
Sixteen articles met the inclusion criteria. The methodology of the identified articles was poor. Six hundred and fifty-one patients, including 478 LS patients and 173 LSD patients, were involved in efficacy and safety evaluations. There was wide variability in the outcome measures between studies. There was only one death in the patients underwent LSD. Reported major complications included post-operative bleeding requiring re-surgery, pancreatic leakage and gastric perforation. Seven studies were identified with comparisons between laparoscopic and open procedures. No meta-analysis was possible because of heterogeneity between studies and lack of randomization.
The publications reviewed revealed LS and LSD to be safe and effective in the setting of liver cirrhosis and portal hypertension. From the comparison articles, laparoscopic procedures appear to be superior to open procedures regarding blood loss, hospital stay, complication rate and liver function impairment. However, it is difficult to draw firm statistical conclusions due to lack of high-quality evidence.
开放性脾切除术和去血管化术是治疗肝硬化伴严重血小板减少症和静脉曲张出血患者的有效方法。然而，腹腔镜脾切除术（LS）和去血管化术（LSD）是否适用于这些患者以及是否有益仍存在争议。
对LS和LSD治疗肝硬化和门静脉高压患者的疗效和安全性进行系统评价，以澄清其在这类患者中应用的争议。
采用系统检索策略从PubMed和Embase.com检索相关研究。文献检索和数据提取由两名评价者独立进行。
16篇文章符合纳入标准。所纳入文章的方法学质量较差。651例患者参与了疗效和安全性评估，其中包括478例行LS的患者和173例行LSD的患者。各研究间结局指标差异很大。接受LSD的患者中仅1例死亡。报告的主要并发症包括需要再次手术的术后出血、胰漏和胃穿孔。7项研究对腹腔镜手术和开放手术进行了比较。由于研究间存在异质性且缺乏随机化，无法进行荟萃分析。
所综述的文献表明，LS和LSD在肝硬化和门静脉高压患者中是安全有效的。从比较文章来看，腹腔镜手术在失血、住院时间、并发症发生率和肝功能损害方面似乎优于开放手术。然而，由于缺乏高质量证据，难以得出确切的统计学结论。
