Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
Surg Endosc. 2019 Apr;33(4):1298-1303. doi: 10.1007/s00464-018-6394-7. Epub 2018 Aug 27.
The benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal-sized spleens have been well documented. However, the role of laparoscopy for moderate and massive splenomegaly is debated.
A retrospective review of patients undergoing elective splenectomy at one institution from 1997 to 2017 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500-1000 g and greater than 1000 g, respectively. We performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight. Differences in perioperative morbidity (infection, thromboembolism, reoperation, readmission), intraoperative factors (blood loss, operative time), length of stay, and mortality were examined.
A total of 491 elective splenectomies were identified. 268 cases were for splenic weights greater than 500 g. After a 1:2 matching of LS:OS, we identified 22 LS and 44 matched OS for moderate splenomegaly. The LS group had longer mean operative times (178 vs. 107 min, p < 0.01), with similar length of stay and blood loss. For massive splenomegaly, 26 LS were identified and matched to 52 OS. LS had longer mean operative times (171 vs. 112 min, p < 0.01) and higher readmission rates (27% vs. 6%, p < 0.05). Other factors and outcomes did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate for LS was higher for massive versus moderate splenomegaly, but was not statistically significant (35% vs. 14%, p = 0.09).
LS for moderate and massive splenomegaly is associated with longer operative times. Other perioperative outcomes were comparable to OS, with no demonstrated benefits for LS. Although LS may be a feasible approach to moderate and massive splenomegaly, its benefits require further clarification in this patient population.
腹腔镜脾切除术（LS）相对于开放性脾切除术（OS）治疗正常大小的脾脏的优势已得到充分证实。然而，腹腔镜在治疗中度和巨脾肿大方面的作用仍存在争议。
对一家机构 1997 年至 2017 年期间行择期脾切除术的患者进行回顾性研究。中度和巨脾肿大的定义分别为脾脏重量为 500-1000g 和大于 1000g。我们对腹腔镜和开放性脾切除术进行了 1:2 匹配，以控制脾脏重量的差异。比较围手术期发病率（感染、血栓栓塞、再次手术、再入院）、术中因素（出血量、手术时间）、住院时间和死亡率的差异。
共确定 491 例择期脾切除术。268 例患者的脾脏重量大于 500g。在 LS：OS 1:2 匹配后，我们发现 22 例 LS 和 44 例匹配的 OS 用于治疗中度脾肿大。LS 组的平均手术时间较长（178 分钟比 107 分钟，p<0.01），但住院时间和出血量相似。对于巨脾肿大，发现 26 例 LS 并与 52 例 OS 匹配。LS 的平均手术时间较长（171 分钟比 112 分钟，p<0.01），再入院率较高（27%比 6%，p<0.05）。中度或巨脾肿大的 LS 和 OS 之间其他因素和结果没有差异。LS 治疗巨脾肿大的转化率高于中度脾肿大，但差异无统计学意义（35%比 14%，p=0.09）。
LS 治疗中度和巨脾肿大与手术时间延长有关。其他围手术期结果与 OS 相当，LS 没有显示出优势。尽管 LS 可能是治疗中度和巨脾肿大的一种可行方法，但在该患者人群中，其优势仍需进一步明确。
