Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.
Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia.
J Laparoendosc Adv Surg Tech A. 2021 Oct;31(10):1130-1142. doi: 10.1089/lap.2020.0769. Epub 2021 Jan 20.
Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.
腹腔镜脾脏部分切除术（LPS）可能可以避免全脾切除术（TS）的并发症，并最大限度地发挥微创方法的优势。本综述的目的是评估 LPS 的可行性和安全性，并将其与其他方法进行比较。对报告 LPS 的文章进行文献回顾。分析了几个参数，包括年龄、适应证、手术技术、用于脾脏分段/止血的设备、不良结果，包括发病率/死亡率、转为开放性手术、转为 TS、手术时间（OT）和住院时间（HS）。还分析了比较 LPS 结果与开放性部分脾切除术和腹腔镜 TS 结果的文章。共纳入 59 篇报告 457 例 LPS 的文章。患者的特征差异很大，涉及年龄和适应证，包括遗传性球形红细胞增多症、镰状细胞贫血病、脾脏局灶性肿块和外伤。报道了几种技术选择。平均 OT 和 HS 分别为 128±43.7 分钟和 4.9±3.8 天。无死亡病例，发病率为 5.7%。转为开放性手术和 TS 的转化率分别为 3.9%和 3.7%。总之，LPS 是可行和安全的，无死亡率，发病率低，转为开放性手术和 TS 的转化率低。LPS 可以通过多种技术和工具来完成。偶尔会报告严重并发症，因此不应低估潜在风险。
