Wang Xin, Wang Mingjun, Zhang Hua, Peng Bing
Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Surg Endosc. 2014 Dec;28(12):3273-8. doi: 10.1007/s00464-014-3600-0. Epub 2014 Jun 18.
Traditionally, splenectomy is considered as the treatment for splenic lesions. The risk of early and late complications and the awareness of immunologic function of spleen have pushed the development of spleen sparing techniques. This study aimed to evaluate the safety and feasibility of laparoscopic partial splenectomy in selected patients.
From May 2011 we initiated performing laparoscopic partial splenectomy in patients with focal benign splenic lesion. The main surgical procedure consisted of four steps: 1. Mobilizing the perisplenic ligaments. 2. Ligating and dissecting the vessels which supplying the involved spleen. 3. Dissecting the spleen along the demarcation. 4. Hemostasis was achieved by bipolar energy device. The perioperative data were collected and analyzed. The follow-up including quality of life and splenic regrowth was routinely undergone 6 months after surgery.
From May 2011 to December 2013, laparoscopic partial splenectomy had been performed on 11 patients aged from 13 to 57 (mean 33). The indications included nonparasitic cyst (n = 6), lymphangioma (n = 3), and hemangioma (n = 2). The mean operative time was 148 min (range 110-200 min). The mean estimated blood loss was 189 ml (range 100-400 ml). One patient converted to total splenectomy because of hemorrhaging. Two patients suffered from postoperative complications: the one who converted to total splenectomy suffered from portal vein thrombosis, the other one underwent partial splenectomy suffered from fluid collection around splenic recess. There was no blood transfusion and postoperative mortality. All patients discharged uneventfully. Seven patients finished the follow-up including evaluation of CT scan and quality of life 6 month after surgery. The results demonstrated all these patients had different degree of splenic regrowth and gained a good quality of life.
Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion. Meanwhile, this technique potentially retains some splenic function, and confers the benefit of a minimal access technique.
传统上，脾切除术被视为脾病变的治疗方法。早期和晚期并发症的风险以及对脾脏免疫功能的认识推动了保脾技术的发展。本研究旨在评估腹腔镜部分脾切除术在特定患者中的安全性和可行性。
从2011年5月起，我们开始对患有局灶性良性脾病变的患者进行腹腔镜部分脾切除术。主要手术步骤包括四个步骤：1. 游离脾周韧带。2. 结扎并解剖供应受累脾脏的血管。3. 沿分界线解剖脾脏。4. 用双极能量设备止血。收集并分析围手术期数据。术后6个月常规进行包括生活质量和脾再生的随访。
从2011年5月至2013年12月，对11例年龄在13至57岁（平均33岁）的患者进行了腹腔镜部分脾切除术。适应证包括非寄生虫性囊肿（n = 6）、淋巴管瘤（n = 3）和血管瘤（n = 2）。平均手术时间为148分钟（范围110 - 200分钟）。平均估计失血量为189毫升（范围100 - 400毫升）。1例患者因出血转为全脾切除术。2例患者出现术后并发症：转为全脾切除术的患者发生门静脉血栓形成，另1例行部分脾切除术的患者出现脾窝积液。无输血及术后死亡情况。所有患者均顺利出院。7例患者完成了术后6个月的随访，包括CT扫描评估和生活质量评估。结果显示所有这些患者均有不同程度的脾再生，生活质量良好。
腹腔镜部分脾切除术对于患有局灶性良性脾病变的患者是安全有效的。同时，该技术有可能保留部分脾功能，并具有微创手术技术的优势。
