Aziret Mehmet, Koyun Bülent, Karaman Kerem, Sunu Cenk, Karacan Alper, Öter Volkan, Çelebi Fehmi, Ercan Metin, Bostancı Erdal Birol
Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey.
Clinic of Hematology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
Turk J Surg. 2020 Mar 18;36(1):72-81. doi: 10.5578/turkjsurg.4535. eCollection 2020 Mar.
Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique.
A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity.
No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery.
Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.
微创手术是最受欢迎的治疗方法之一，在不同临床实践中，经验丰富的医生操作时它安全且有效。在本研究中，我们旨在评估转为开腹脾切除术的危险因素以及间接脾门解剖技术的效果。
本研究纳入了56例因孤立性脾脏疾病接受腹腔镜或机器人辅助脾切除术的患者。患者被分为两组，即机器人辅助或腹腔镜脾切除术组（第1组；n = 48）和转为开放手术组（第2组；n = 8）。根据临床、生化、血液学和微生物学参数以及发病率对患者进行回顾性评估。
两组在年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）评分、合并疾病、手术时间、住院时间、随访期、副脾、诊断、国际标准化比值（INR）、红细胞分布宽度（RDW）、血小板分布宽度（PDW）、血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）、再次手术、脾种植、手术部位感染、血管血栓和切口疝方面，差异均无统计学意义（p>0.05）。另一方面，转为开放手术组的术中脾门出血和脾脏增大（p<0.05）发生率更高。在逻辑回归分析中，术中脾门出血（B = 4.127）（OR = 61.974）（95%可信区间 = 3.913 - 981.454）（p = 0.003）和脾脏体积增大（B = 3.114）（OR = 22.509）（95%可信区间 = 1.818 - 278.714）（p = 0.015）被发现是转为开放手术的危险因素。
对于接受择期机器人辅助或腹腔镜脾切除术的患者，术中脾门出血和脾脏体积增大（>400 cm³）是转为开腹脾切除术的危险因素。间接脾门解剖可减少术中出血和转为开放手术的几率。
