Esposito Francesco, Noviello Adele, Moles Nicola, Cantore Nicola, Baiamonte Mario, Coppola Bottazzi Enrico, Miro Antonio, Crafa Francesco
Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy.
Department of Hematology and Stem Cell Transplantation, S.G. Moscati Hospital, Avellino, Italy.
Ann Hepatobiliary Pancreat Surg. 2018 May;22(2):116-127. doi: 10.14701/ahbps.2018.22.2.116. Epub 2018 May 30.
BACKGROUNDS/AIMS: Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches.
Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients.
Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5-50%) and in 3% of cases (range, 7-10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5-25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%).
The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.
背景/目的：部分脾切除术（PS）是治疗脾脏肿物的一种手术选择，目的是减少术后并发症并保留脾脏功能。尽管如此，文献中的数据仍然稀少。本研究旨在揭示我们最近的经验，并全面概述与各种手术方法相关的可行性和并发症。
回顾性分析2014年至2017年间接受PS治疗的患者的数据。检索文献，查找报告成人或青少年患者各种类型PS的研究。
我们科室共进行了5例PS手术：2例（40%）通过腹腔镜手术，3例（60%）通过开腹手术。检测到2例（40%）术后并发症，其中1例最终需要通过开腹手术进行全脾切除术（TS）。最后一次随访时无死亡或并发症发生。在文献检索中确定了20项研究，包括213例患者。腹腔镜手术转为开放手术的比例为3%（范围为5%-50%），3%的病例（范围为7%-10%）PS转为全脾切除术，总体发病率为8%（范围为5%-25%）。与开腹手术相比，腹腔镜手术转为TS的比例为3.5%（vs. 1.4%），发病率为9.8%（vs. 4.3%）。
本综述表明，PS在特定病例中是一种可行的手术。尽管微创方法的并发症发生率高于开放技术，但似乎是可行的。未来，需要纳入更多患者对该主题进行进一步研究。此外，有人提出机器人手术的发展可能使这种方法成为保脾手术的新金标准技术。
