Shakya Vikal Chandra, Byanjankar Bikram, Pandit Rabin, Pangeni Anang, Shrestha Anir Ram Moh, Poudyal Bishesh
Department of Surgery, Civil Service Hospital of Nepal, Kathmandu, Nepal.
Clinical Hematology and Bone Marrow Transplant Unit, Department of Medicine, Civil Service Hospital of Nepal, Kathmandu, Nepal.
Minim Invasive Surg. 2018 Aug 1;2018:4256570. doi: 10.1155/2018/4256570. eCollection 2018.
Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country.
This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016.
There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were 62000 ± 11000/mm3 (range 52000-325000/mm3). The mean operative time was 130 ± 49 minutes (range 108-224 min). The mean postoperative stay was 4 ± 2.11 days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients.
Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach.
尽管在发达国家，腹腔镜手术目前是脾切除术的金标准，但在东方国家我们在这方面仍有所欠缺。在我们地区，脾切除术大多通过开放手术进行。这是我们在本国引入腹腔镜脾切除术的努力。
这是一项回顾性队列研究，研究对象为2013年1月至2016年12月期间在我院血液科和外科接受腹腔镜脾切除术治疗血液系统疾病的患者。
共有50例患者（女性38例，男性12例）。诊断包括31例特发性血小板减少性紫癜（对类固醇/硫唑嘌呤耐药、类固醇依赖）、9例遗传性球形红细胞增多症、3例α地中海贫血、2例β地中海贫血、4例自身免疫性溶血性贫血和1例孤立性脾结核。术前平均血小板计数为62000±11000/mm³（范围52000 - 325000/mm³）。平均手术时间为130±49分钟（范围108 - 224分钟）。平均术后住院时间为4±2.11天（范围3 - 9天）。45例（90%）患者成功完成腹腔镜脾切除术。
对于血液系统疾病患者，尤其是脾脏正常或仅轻度肿大的患者，腹腔镜脾切除术是一种可行的选择，是开放脾切除术的有利替代方法。缺乏理想资源并未限制我们在微创方法上的进展。
