改良脾门悬挂法在腹腔镜脾切除术中的应用价值，尤其是对巨大脾脏患者：一项倾向评分匹配的病例对照研究。

The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching.

机构信息

Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

出版信息

Surg Endosc. 2022 Feb;36(2):911-919. doi: 10.1007/s00464-021-08348-7. Epub 2021 Feb 16.

DOI:10.1007/s00464-021-08348-7

PMID:33594584

Abstract

BACKGROUND

Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube.

METHODS

Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses.

RESULTS

After the propensity score matching, blood loss (268 ml vs. 50 ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15 days vs. 10 days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802 ml (sensitivity: 0.684, specificity: 0.827, p < 0.001).

CONCLUSIONS

LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.

摘要

背景

腹腔镜脾切除术（LS）已被证明是脾切除的标准手术，但转换为开放手术的比率仍然高于其他腹腔镜手术，尤其是对于巨大脾脏。为了降低开放手术的转化率，我们开发了使用改良脾门悬挂（MSHH）操作的 LS：使用无创伤性的 Penrose 引流管悬挂脾门后，整块切断脾蒂。

方法

我们回顾性评估了 2005 年 1 月至 2019 年 12 月期间接受 LS 的 94 例患者。37 例患者（39.4%）进行了 MSHH 操作。我们比较了有或没有 MSHH 操作的患者的围手术期结果。为了调整术前特征和血液检查的差异，使用倾向评分匹配以 1:1 的比例进行比较，每组比较 29 例患者。使用单变量和多变量分析阐明了从 LS 转为开放手术的预测因素。

结果

经过倾向评分匹配后，MSHH 操作组的术中出血量（268ml 比 50ml）、转为开放手术的比例（27.6%比 0%）和术后住院时间（15 天比 10 天）均显著降低。94 例患者中，19 例（20.2%）转为开放手术。多变量分析中，脾脏体积（SV）和 LS 无 MSHH 操作分别是转为开放手术的独立预测因素。此外，SV 转为开放手术的截断值为 802ml（灵敏度：0.684，特异性：0.827，p<0.001）。