Hepatobiliary Surgery and Liver Transplant Center, A. Cardarelli Hospital, Naples, Italy.
Updates Surg. 2013 Jun;65(2):115-9. doi: 10.1007/s13304-013-0197-0. Epub 2013 Jan 26.
Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers.
腹腔镜脾切除术（LS）现在被认为是大多数需要脾切除术的血液系统疾病的金标准，但仍有许多问题存在。本研究的目的是分析我们 5 年来的经验，包括 48 例连续的 LS 病例，以评估该手术在恶性疾病和不常见病例（如原发性脾淋巴瘤、大脾动脉动脉瘤或因巨大胰腺假性囊肿引起的脾梗死）中的最佳方法和可行性。48 例连续患者于 2006 年 1 月至 2011 年 1 月接受 LS 治疗，至少随访 1 年。回顾性记录临床资料和近期结果；分析年龄、诊断、手术时间、围手术期输血需求、转化率、辅助切口、住院时间和并发症。我们有 14 例恶性脾疾病，最常见的恶性诊断是非霍奇金淋巴瘤（12/14，85.7%）。12 例（25%）存在脾肿大（中极直径（ID）>20cm），3 例（6.25%）存在巨大脾肿大（ID>25cm）。2 例（4.16%）因脾肿大患者无法控制的出血而转为开腹手术。平均手术时间为 138±22 分钟。平均住院时间为 4.5 天。良性组术后发病率为 8.8%，恶性组为 35.7%。48 例患者中 1 例（2.08%）死亡，原因是脾切除术后感染（OPSI）。LS 可安全用于恶性脾疾病和脾肿大，发病率和死亡率无显著增加。对于巨大脾肿大，转化率增加。LS 应被视为首选方法，即使在恶性疾病、脾肿大或不常见病例的患者中也是如此。即使在经验丰富的中心，巨大脾肿大也应被视为 LS 的相对禁忌症。
