Wang Dong, Chen Xiao, Lv Ling, Yang Tao, Huang Bo, Cao Yanlong, Lu Jianguo, Yin Jikai
Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Department of Disease Prevention and Health Care, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Ann Transl Med. 2022 Feb;10(4):207. doi: 10.21037/atm-22-502.
In China, laparoscopic splenectomy and esophagogastric devascularization (LSED) are effective and safe tools that are used to treat esophageal-fundic variceal bleeding with portal hypertension (PHT) with minimal trauma; however, due to the increased difficulty of operation, their application in massive splenomegaly (MS) remains limited. This study sought to determine the efficacy and safety of LSED in treating MS patients with PHT.
The data of 124 patients who underwent LSED by a single surgical team at our department from January 2015 to December 2020 were retrospectively analyzed. The characteristics of the patients, perioperative parameters, and long-term follow-up data were examined.
A total of 61 MS and 63 mild-to-moderate splenomegaly (MMS) patients underwent LSED. Much larger spleen and significant lower of white blood cells and platelets was found in MS group compared the MMS group preoperation (P<0.05). The MS group had a significantly longer operation time (P=0.009), more blood loss (P=0.003), and more abdominal drainage days (P=0.017) than the MMS group. Four patients in the MS group and 0 patients in the MMS group were converted to open surgery. No significant difference was found between the 2 groups in terms of postoperative complications. Nine patients in the MMS group and 10 in the MMS group experienced recurrent bleeding in the follow-up period, but no significant differences were observed in terms of recurrent bleeding and overall survival (OS) between the 2 groups.
LSED can be used to treat MS patients with PHT under careful perioperative management. For experienced surgeons, LSED is a safe, feasible, and minimally invasive procedure with satisfactory long-term outcomes that can be used to treat MS patients with PHT.
Laparoscopic splenectomy (LS); massive splenomegaly (MS); devascularization; portal hypertension (PHT).
在中国，腹腔镜脾切除术联合食管胃去血管化术（LSED）是治疗门静脉高压症（PHT）所致食管胃底静脉曲张出血的有效且安全的微创治疗手段；然而，由于手术难度增加，其在巨脾症（MS）中的应用仍然有限。本研究旨在确定LSED治疗PHT合并MS患者的疗效及安全性。
回顾性分析2015年1月至2020年12月在我科由同一手术团队实施LSED的124例患者的数据。考察患者特征、围手术期参数及长期随访数据。
共有61例MS患者和63例轻至中度脾肿大（MMS）患者接受了LSED。与MMS组相比，MS组术前脾脏明显更大，白细胞和血小板显著更低（P<0.05）。MS组手术时间明显更长（P=0.009），失血量更多（P=0.003），腹腔引流天数更多（P=0.017）。MS组有4例患者转为开腹手术，MMS组无患者转为开腹手术。两组术后并发症方面无显著差异。随访期间，MMS组有9例患者、MS组有10例患者出现复发出血，但两组在复发出血和总生存期（OS）方面无显著差异。
在精心的围手术期管理下，LSED可用于治疗PHT合并MS的患者。对于经验丰富的外科医生而言，LSED是一种安全、可行且微创的手术，长期效果良好，可用于治疗PHT合并MS的患者。
腹腔镜脾切除术（LS）；巨脾症（MS）；去血管化；门静脉高压症（PHT）
