Sun Xiangyu, Liu Zhou, Selim M H, Huang Yong
Department of Minimally Invasive Surgical Centre, Tianjin Nankai Hospital, Tianjin.
Department of Internal medicine, The Third People's Hospital of Jiangxi Province.
Surg Laparosc Endosc Percutan Tech. 2019 Apr;29(2):109-112. doi: 10.1097/SLE.0000000000000640.
Laparoscopic splenectomy (LS) is generally applied for splenectomy, However, it also brings some technical challenges, especially for splenomegaly. Hand-assisted laparoscopic splenectomy (HALS) can help to overcome these drawbacks while maintaining the superiority of LS. This study was aimed to evaluate the efficacy and advantage of HALS for splenomegaly.
Between January 2014 and November 2017, 91 patients with splenomegaly in 2 surgical centers were randomly assigned to either HALS (n=45) or LS (n=46). The patients' characteristics, intraoperative details, and the postoperative outcomes in both groups were compared.
Baseline features (sex, age, main diameter, Child-Pugh grade) of both groups had no significant difference (P<0.05). Compared with LS group, the HALS group operation time (141±46 vs. 172±43 min; P=0.001) was shorter, intraoperative blood loss [215 (122.332) vs. 230 (130.740) mL; P=0.026], hospital expenses (5.5±1.5 vs. 6.4±2.4 WanRMB; P=0.022), and conversion rate (1/45 vs. 9/46; P=0.015) were lower. However, there was no significant difference for hospital stay (6.4±2.8 vs. 6.7±3.0 d; P=0.662) and complications (15/45 vs. 12/46; P=0.893) between the 2 groups. In addition, there were no significant differences in postoperative white blood cell (10.6±2.9 vs. 10.9±3.5; P=0.747), AST [61 (47.94) vs. 57 (37.86) U/L; P=0.513], and ALT [68 (54.120) vs. 55 (36.99) U/L; P=0.302] levels.
HALS can maximize the benefits for patients, while maintaining the advantages of LS and open splenectomy. It is the ideal surgical treatment for splenomegaly.
腹腔镜脾切除术（LS）通常用于脾切除，但它也带来了一些技术挑战，尤其是对于脾肿大患者。手辅助腹腔镜脾切除术（HALS）有助于克服这些缺点，同时保持LS的优势。本研究旨在评估HALS治疗脾肿大的疗效和优势。
2014年1月至2017年11月期间，2个手术中心的91例脾肿大患者被随机分为HALS组（n = 45）和LS组（n = 46）。比较两组患者的特征、术中细节及术后结果。
两组的基线特征（性别、年龄、脾最大径、Child-Pugh分级）无显著差异（P>0.05）。与LS组相比，HALS组的手术时间较短（141±46 vs. 172±43分钟；P = 0.001），术中出血量较少[215（122,332）vs. 230（130,740）mL；P = 0.026]，住院费用较低（5.5±1.5 vs. 6.4±2.4万元人民币；P = 0.022），中转开腹率较低（1/45 vs. 9/46；P = 0.015）。然而，两组的住院时间（6.4±2.8 vs. 6.7±3.0天；P = 0.662）和并发症发生率（15/45 vs. 12/46；P = 0.893）无显著差异。此外，两组术后白细胞水平（10.6±2.9 vs. 10.9±3.5；P = 0.747）、谷草转氨酶[61（47,94）vs. 57（37,86）U/L；P = 0.513]和谷丙转氨酶[68（54,120）vs. 55（36,99）U/L; P = 0.302]无显著差异。
HALS在保持LS和开放性脾切除术优势的同时，能使患者获得最大受益。它是治疗脾肿大的理想手术方式。
