Casaccia Marco, Sormani Maria P, Palombo Denise, Dellepiane Clara, Ibatici Adalberto
Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University.
Unit of Clinical Epidemiology and Trials.
Surg Laparosc Endosc Percutan Tech. 2019 Jun;29(3):178-181. doi: 10.1097/SLE.0000000000000637.
The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD)>20 cm] and giant spleens (SLD>25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143±31 vs. 112±40 min; P=0.001), less blood loss (278±302 vs. 575±583 mL; P=0.007), and shorter hospital stay (6±3 vs. 9±4 d; P=0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P=0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal "working space." In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.
本研究的目的是得出一些有用参数，以界定腹腔镜脾切除术（LS）用于巨大脾脏（脾纵径[SLD]>20 cm）和特大脾脏（SLD>25 cm）时的可行性。1996年12月至2017年5月期间，175例患者接受了择期脾切除术。133例（76%）患者采用了腹腔镜手术方式。65例（37.1%）患者为巨大脾脏，其中24例行腹腔镜手术。在这一巨大脾脏亚组中，比较了巨大脾脏腹腔镜脾切除术（LSM）和巨大脾脏开放性脾切除术（OSM）的结果。还分析了特大脾脏患者亚组的临床结局。LSM组手术时间显著更长（143±31 vs. 112±40分钟；P=0.001），失血量更少（278±302 vs. 575±583毫升；P=0.007），住院时间更短（6±3 vs. 9±4天；P=0.004）。LSM组无中转开腹情况，LSM组和OSM组的发病率相似（16.6% vs. 20%；P=0.75）。在考虑9例LSM患者和26例OSM特大脾脏患者的亚组时，腹腔镜组在手术中转、失血量和住院时间方面保持了相同的良好趋势。在对预期腹部“操作空间”进行仔细的术前评估后，即使存在巨大脾肿大，腹腔镜手术方式也可成功实施。在经验丰富的医生手中，LS治疗巨大和特大脾脏安全、可行，且与开放性脾切除术相比结局更好，SLD最大限制为31 cm。
