Gonçalves Diana, Morais Marina, Costa-Pinho André, Bessa-Melo Renato, Graça Luís, Costa-Maia J
1 Department of Surgery, Sao Joao Medical Center , Porto, Portugal .
2 Faculty of Medicine of the University of Porto , Porto, Portugal .
J Laparoendosc Adv Surg Tech A. 2018 Mar;28(3):242-247. doi: 10.1089/lap.2017.0478. Epub 2017 Oct 11.
Laparoscopic splenectomy (LS) is the gold standard for the treatment of many spleen-related disorders. However, in the presence of splenomegaly, the rate of conversion to open surgery can be as high as 33.9% and is associated with longer operative times and higher costs. In an attempt to improve risk stratification and patient selection for LS, a score that includes four preoperative parameters (age, gender, diagnosis, and spleen size) has been developed. The aim was the validation of a difficulty grading score, in predicting conversion and poorer outcomes.
Retrospective analysis of 153 consecutive patients subjected to LS from January 2006 through December 2016 was performed. Several parameters were reviewed and correlation with evaluated outcomes was analyzed.
Conversion to open surgery occurred in 13 (8.50%) patients and was highly associated with serious intraoperative complications. Spearman correlation showed a significant association between the score and risk of conversion, operative time, and postoperative complications, but not with intraoperative bleeding.
Patient and disease features, incorporated in a difficulty grading score, can reliably determine the difficulty of LS and predict risk of conversion, intraoperative, and postoperative complications. This simple and reproducible score improves risk stratification for LS and could be practical in daily clinical activities.
腹腔镜脾切除术（LS）是治疗多种脾脏相关疾病的金标准。然而，在脾肿大的情况下，转为开放手术的比率可高达33.9%，且与更长的手术时间和更高的费用相关。为了改善LS的风险分层和患者选择，已制定了一个包含四个术前参数（年龄、性别、诊断和脾脏大小）的评分系统。目的是验证一个难度分级评分系统在预测手术转为开放手术及较差预后方面的有效性。
对2006年1月至2016年12月期间连续接受LS的153例患者进行回顾性分析。回顾了多个参数，并分析了其与评估结果的相关性。
13例（8.50%）患者转为开放手术，且与严重的术中并发症高度相关。Spearman相关性分析显示，该评分与手术转为开放手术的风险、手术时间和术后并发症之间存在显著关联，但与术中出血无关。
纳入难度分级评分系统的患者和疾病特征能够可靠地确定LS的难度，并预测手术转为开放手术的风险、术中及术后并发症。这个简单且可重复的评分系统改善了LS的风险分层，在日常临床活动中可能具有实用性。
