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急诊腹腔镜部分脾切除术的可行性与安全性:一项回顾性分析。

Feasibility and safety of emergency laparoscopic partial splenectomy: A retrospective analysis.

作者信息

Li Hongyu, Wei Yonggang, Peng Bing, Li Bo, Liu Fei

机构信息

aDepartment of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province bDepartment of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

出版信息

Medicine (Baltimore). 2017 Apr;96(16):e6450. doi: 10.1097/MD.0000000000006450.

Abstract

The increased awareness of asplenia-related life-threatening complications has led to the development of parenchyma sparing splenic resections in past few years. The aim of this study is to retrospectively analyze the feasibility and safety of laparoscopic partial splenectomy (LPS) in selected emergency patients.From January 2013 to December 2015, there were 46 emergency patients, diagnosed with splenic rupture, admitted in our department. Selection criteria for LPS: (1) Preoperative CT scan revealed single pole rupture without spleen pedicle injury; (2) BP>90/60 mm Hg and heart rates <120 bpm; (3) No sigh of multiple organ injury. Eventually, LPS was performed in 21 patients (Group LPS), while laparoscopic splenectomy (LS) was performed in 20 patients (Group LS).The main cause of splenic rupture was traffic accident, followed by blunt injury and high falling injury. Abdominal CT scan showed the mean longitudinal diameter of spleen of group LPS was 14.2 ± 1.8 cm (range 12-17 cm), while the size of remnant spleen was 5.5 ± 1.2 cm. Between 2 groups, operation time (LPS: 122.6 ± 17.2 min vs LS: 110.5 ± 18.7 minutes, P = .117), and intraoperative blood loss (LPS: 174 ± 22 mL vs LS: 169 ± 29 mL, P = .331) were similar. There were 2 patients suffered subsequent unstable vital sign altering during mobilization when performing LPS. Conversion to LS (2/21, 9.52%) was decided and successfully completed. Although there was no patient suffered postoperative OPSI or thrombocytosis events in both groups after 6-month follow-up, the mean platelets and leukocyte count were significantly lower in group LPS. Splenic regrowth was evaluated in 20 patients of group LPS. And the mean regrowth of splenic volume reached 19% (10%-26%).Due to its minimal invasive effect and functional splenic tissue preservation, LPS may be a safe and feasible approach for emergency patients. And prospective trials with clear inclusion criteria are needed to proof the benefit of LPS.

摘要

在过去几年中,由于对无脾相关的危及生命并发症的认识不断提高,促使了保留实质的脾切除术的发展。本研究的目的是回顾性分析腹腔镜部分脾切除术(LPS)在特定急诊患者中的可行性和安全性。2013年1月至2015年12月,我科收治了46例诊断为脾破裂的急诊患者。LPS的选择标准:(1)术前CT扫描显示单极破裂且无脾蒂损伤;(2)血压>90/60 mmHg且心率<120次/分钟;(3)无多器官损伤迹象。最终,21例患者接受了LPS(LPS组),20例患者接受了腹腔镜脾切除术(LS,LS组)。脾破裂的主要原因是交通事故,其次是钝器伤和高处坠落伤。腹部CT扫描显示,LPS组脾脏的平均纵径为14.2±1.8 cm(范围12 - 17 cm),而残余脾脏大小为5.5±1.2 cm。两组之间,手术时间(LPS组:122.6±17.2分钟 vs LS组:110.5±18.7分钟,P = 0.117)和术中出血量(LPS组:174±22 mL vs LS组:169±29 mL,P = 0.331)相似。在进行LPS时,有2例患者在分离过程中出现生命体征不稳定变化。决定转为LS(2/21,9.52%)并成功完成。尽管6个月随访后两组均无患者发生术后暴发性感染或血小板增多症事件,但LPS组的平均血小板和白细胞计数显著降低。对LPS组的20例患者评估了脾再生情况。脾体积的平均再生率达到19%(10% - 26%)。由于其微创效果和保留功能性脾组织,LPS可能是急诊患者的一种安全可行的方法。需要进行具有明确纳入标准的前瞻性试验来证明LPS的益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/43d5/5406050/5fca7109cc28/medi-96-e6450-g001.jpg

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