Tian Guangjin, Li Deyu, Yu Haibo, Dong Yadong, Xue Huanzhou
Am Surg. 2018 Jun 1;84(6):1033-1038.
This study was performed to evaluate the feasibility of the splenic bed laparoscopic splenectomy approach (SBLS) for massive splenomegaly (≥30 cm) in patients with hypersplenism secondary to portal hypertension and liver cirrhosis. Patients who underwent laparoscopic splenectomy (LS) from January 2012 to December 2016 were retrospectively reviewed. We performed LS in 83 patients with massive splenomegaly (≥30 cm) secondary to portal hypertension and liver cirrhosis. Of these patients, 37 underwent the SBLS and 46 underwent anterior LS (ALS). Five patients in the ALS group and none in the SBLS group underwent conversion to open surgery. The operation time, intraoperative blood loss volume, transfusion volume, frequency of transfusion, hemorrhage of short gastric vessels, conversion rate, postoperative hospital stay, and incidence of pancreatic fistula were all significantly lower in the SBLS than ALS group (all P < 0.05). No death or postoperative bleeding occurred in the two groups, and there were no significant differences in age, gender, spleen size, hemoglobin level, platelet count, prothrombin time, Child-Pugh class, hypoproteinemia, or ascites (all P > 0.05). The SBLS is more feasible and effective than ALS in patients with massive splenomegaly (≥30 cm) secondary to portal hypertension and liver cirrhosis.
本研究旨在评估脾床腹腔镜脾切除术（SBLS）治疗门静脉高压和肝硬化继发脾功能亢进且脾肿大（≥30 cm）患者的可行性。回顾性分析2012年1月至2016年12月期间接受腹腔镜脾切除术（LS）的患者。我们对83例门静脉高压和肝硬化继发脾肿大（≥30 cm）的患者进行了LS。其中，37例接受了SBLS，46例接受了前入路腹腔镜脾切除术（ALS）。ALS组有5例患者转为开腹手术，SBLS组无患者转为开腹手术。SBLS组的手术时间、术中失血量、输血量、输血频率、胃短血管出血、转化率、术后住院时间和胰瘘发生率均显著低于ALS组（均P<0.05）。两组均未发生死亡或术后出血，在年龄、性别、脾脏大小、血红蛋白水平、血小板计数、凝血酶原时间、Child-Pugh分级、低蛋白血症或腹水方面无显著差异（均P>0.05）。对于门静脉高压和肝硬化继发脾肿大（≥30 cm）的患者，SBLS比ALS更可行且有效。
