Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
World J Surg. 2013 Sep;37(9):2046-52. doi: 10.1007/s00268-013-2114-6.
Laparoscopic splenectomy (LS) is significantly more challenging in patients with supramassive splenomegaly and those with portal hypertension. We hypothesized that hand-assisted laparoscopic splenectomy (HALS) could facilitate the procedure in these patients.
Before October 2009, patients with supramassive splenomegaly and those with portal hypertension underwent LS. After October 2009, we routinely applied HALS in patients with these disorders.
We compared the HALS group (n = 41) with the LS group (n = 45). There were no conversions to open surgery in the HALS group, whereas there was an 4.5 % conversion rate in the LS group. The operating times were shorter, and there was less estimated blood loss, and fewer major complications in the HALS group. Analgesia requirement, time to full diet, and postoperative stay were comparable in the two groups.
We concluded that HALS was superior to LS in patients with supramassive splenomegaly and in those with portal hypertension.
腹腔镜脾切除术（LS）在巨大脾肿大和门静脉高压患者中具有更大的挑战性。我们假设手助腹腔镜脾切除术（HALS）可以为这些患者提供便利。
在 2009 年 10 月之前，巨大脾肿大和门静脉高压患者接受 LS 治疗。2009 年 10 月之后，我们常规在手助腹腔镜下为这些患者进行手术。
我们比较了 HALS 组（n=41）和 LS 组（n=45）。HALS 组无中转开腹手术，而 LS 组的中转开腹率为 4.5%。HALS 组的手术时间更短，估计出血量更少，主要并发症更少。两组的镇痛需求、恢复全饮食时间和术后住院时间相似。
我们得出结论，在手助腹腔镜下为巨大脾肿大和门静脉高压患者进行手术优于 LS。
