2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
Int J Surg. 2018 Apr;52:285-292. doi: 10.1016/j.ijsu.2018.02.042. Epub 2018 Feb 23.
Laparoscopic splenectomy (LS) has become the gold standard in elective spleen surgery. Although it is considered relatively safe, treatment results vary depending on a hospital's profile and the experience of the surgeon and center. We would like to present experience of a high-volume referral center with minimally invasive operations of the spleen.
The retrospective cohort study included consecutive patients undergoing laparoscopic splenectomy in tertiary referral surgical center in 1998-2017. The entire study population (500 patients) was grouped into 5 cohorts of 100 consecutively operated patients. The primary endpoints were short-term outcomes of LS and secondary - analysis of indications and operative technique. The study group consisted of 316 women and 184 men, 46 (28-59) years old on average.
The most common indications for splenectomy were ITP (53%), lymphoma (21%) and spherocytosis (7%). Ratio of ITP versus other indications decreased significantly over time in favor of more difficult cases (<0.001). Average operative time of 100 (75-132.5) min and blood loss of 50 (20-150) ml were changing during study. Forty two patients required a blood transfusion with no difference among groups (p = 0.765). The use of postoperative drainage diminished from 100% to 7% (p < 0.001). The overall conversion rate (3%) and intraoperative complications (5%) did not differ among groups (p = 0.863 and 0.888). Perioperative morbidity was 8.6% and decreased significantly over time (OR: 0.78, 95%CI: 0.62-0.98). We noted mortality of 0.4% (1 patient in 1st and 1 in 5th group). Median LOS was 4 (1-16) days. A significant change in the operative technique from vessels first to hilar transection was noted.
Laparoscopic splenectomy seems to be a safe method associated with a low risk of perioperative complications and mortality. A careful reproducible operative technique, along with a well-trained team and standardized modern postoperative care is critical to improving outcomes.
腹腔镜脾切除术（LS）已成为择期脾手术的金标准。虽然它被认为相对安全，但治疗结果因医院的类型、外科医生和中心的经验而异。我们希望介绍一家高容量转诊中心在微创脾手术方面的经验。
这项回顾性队列研究纳入了 1998 年至 2017 年在三级转诊外科中心接受腹腔镜脾切除术的连续患者。整个研究人群（500 例患者）分为 5 个 100 例连续手术的队列。主要终点是 LS 的短期结果，次要终点是手术适应证和手术技术的分析。研究组包括 316 名女性和 184 名男性，平均年龄为 46（28-59）岁。
脾切除术的最常见适应证是特发性血小板减少性紫癜（ITP）（53%）、淋巴瘤（21%）和球形红细胞增多症（7%）。ITP 与其他适应证的比例随时间推移而显著下降，有利于更困难的病例（<0.001）。手术时间平均为 100（75-132.5）分钟，失血量为 50（20-150）毫升，在研究期间发生变化。42 例患者需要输血，各组之间无差异（p=0.765）。术后引流的使用从 100%减少到 7%（p<0.001）。总的中转率（3%）和术中并发症（5%）在各组之间没有差异（p=0.863 和 0.888）。围手术期发病率为 8.6%，且随时间显著下降（OR：0.78，95%CI：0.62-0.98）。我们注意到死亡率为 0.4%（第 1 组和第 5 组各 1 例）。中位 LOS 为 4（1-16）天。我们注意到从血管优先到肝门横断的手术技术有显著变化。
腹腔镜脾切除术似乎是一种安全的方法，其围手术期并发症和死亡率的风险较低。仔细、可重复的手术技术，加上训练有素的团队和标准化的现代术后护理，对于改善结果至关重要。
