Vecchio Rosario, Milluzzo Sebastian M, Troina Graziano, Cacciola Emma, Cacciola Rossella R, Catalano Renato S, Caputo Marco
Laparoscopic Surgery Unit, Department of Surgery, University of Catania, Policlinico V. Emanuele Hospital, Catania, Italy.
Surg Laparosc Endosc Percutan Tech. 2018 Jun;28(3):e63-e67. doi: 10.1097/SLE.0000000000000522.
Presently, laparoscopic splenectomy (LS) is being performed for several indications in clinical practice. However, conversion to open surgery is occasionally required in some patients. We analyzed the intraoperative indications and potential preoperative predictors associated with conversion to open surgery in those presenting for LS.
We reviewed 107 patients who underwent LS. We analyzed the surgical indications, spleen size, surgical procedure performed, operative time, rate of and indications for conversions, as well as postoperative complications.
Among the 15 patients (14.0%) who underwent conversion, the conversion was related to the occurrence of a splenic lymphoma in 10, severe bleeding in 3, a lack of anatomic definition in 1, and splenic candidiasis in 1 patient. A comparison between the results obtained in the initial 30 patients (LS performed during the learning curve) and those obtained in the remaining 77 patients, showed that conversions appeared to be related to the experience/expertise of the surgical team excluding patients with splenic malignancies. Conversion was not associated with a higher morbidity-mortality rate, but only a longer length of hospitalization.
LS is a gold standard procedure when performed by experienced and competent surgeons. However, careful patient selection is recommended before using the laparoscopic approach in those presenting with splenic malignancies.
目前，腹腔镜脾切除术（LS）在临床实践中有多种适应证。然而，部分患者偶尔需要转为开放手术。我们分析了接受LS患者中转开腹手术的术中指征及潜在术前预测因素。
我们回顾了107例行LS的患者。分析了手术适应证、脾脏大小、所实施的手术方式、手术时间、中转率及指征，以及术后并发症。
在15例（14.0%）中转开腹的患者中，10例与脾淋巴瘤的发生有关，3例因严重出血，1例因解剖结构不清，1例因脾念珠菌病。对最初30例患者（学习曲线期间实施的LS）与其余77例患者的结果进行比较，结果显示，排除脾恶性肿瘤患者后，中转似乎与手术团队的经验/专业技能有关。中转与较高的发病率和死亡率无关，但仅住院时间较长。
由经验丰富且技术熟练的外科医生实施时，LS是一种金标准术式。然而，对于脾恶性肿瘤患者，在采用腹腔镜手术方法前建议仔细选择患者。
