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腹腔镜脾次全切除术:治疗脾转移瘤的可行选择

Laparoscopic Subtotal Splenectomy: A Feasible Option in the Treatment of Splenic Metastasis.

作者信息

Izquierdo Cristina, García-Picazo Alberto, Rodríguez Juan Pablo, Navarro Anna, Donisi Greta, Luque Eduardo, Ielpo Benedetto, Burdío Fernando, Sánchez-Velázquez Patricia

机构信息

Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Universitat Pompeu-Fabra, Barcelona, Spain.

出版信息

Ann Surg Oncol. 2025 Feb;32(2):1232-1235. doi: 10.1245/s10434-024-16549-2. Epub 2024 Nov 22.

Abstract

INTRODUCTION

Laparoscopic subtotal splenectomy (LSS) is a procedure that helps avoid the consequences of asplenia. Given the spleen's importance and functionality, there may be specific indications and patient conditions in which partial splenectomy is beneficial. This case report aims to clarify the indications for LSS and outline the surgical technique.

METHODS

This multimedia article provides a comprehensive overview of the surgical procedure, emphasizing key steps to avoid postoperative bleeding and complications.

RESULTS

The patient was hospitalized for 3 days without any complications observed. Postoperative hemoglobin levels were 11.2 g/dL, with no signs of anemia. The patient was discharged with a follow-up visit after 2 weeks, showing no evidence of postoperative complications. The anatomopathological study revealed a nodular area with extensive tumoral necrosis.

DISCUSSION

LSS is a safe surgical option that might help to mitigate the consequences of total splenectomy. Innovative technology in hemostasis, such as COOLINGBIS (a monopolar electrosurgical electrode designed for hemostatic sealing and coagulation) can help manage this risk. Identifying the vascular pedicle via computed tomography scan is crucial to prevent unexpected bleeding.

CONCLUSIONS

In selected cases, LSS is a feasible and safe procedure when performed with appropriate laparoscopic equipment and by experienced surgeons.

摘要

引言

腹腔镜脾次全切除术(LSS)是一种有助于避免无脾后果的手术。鉴于脾脏的重要性和功能,在某些特定的适应症和患者情况下,部分脾切除术可能是有益的。本病例报告旨在阐明LSS的适应症并概述手术技术。

方法

这篇多媒体文章全面概述了该手术过程,强调了避免术后出血和并发症的关键步骤。

结果

患者住院3天,未观察到任何并发症。术后血红蛋白水平为11.2 g/dL,无贫血迹象。患者在2周后出院并进行随访,未发现术后并发症的迹象。解剖病理学研究显示一个有广泛肿瘤坏死的结节区域。

讨论

LSS是一种安全的手术选择,可能有助于减轻全脾切除术的后果。止血方面的创新技术,如COOLINGBIS(一种用于止血密封和凝血的单极电外科电极)有助于管理这种风险。通过计算机断层扫描识别血管蒂对于预防意外出血至关重要。

结论

在特定病例中,当使用适当的腹腔镜设备并由经验丰富的外科医生进行操作时,LSS是一种可行且安全的手术。

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Laparoscopic subtotal splenectomy.腹腔镜脾次全切除术。
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本文引用的文献

1
[Surgery for primary splenic tumors and metastases of the spleen].[原发性脾脏肿瘤及脾脏转移瘤的手术治疗]
Chirurgie (Heidelb). 2023 Dec;94(12):994-999. doi: 10.1007/s00104-023-01978-8. Epub 2023 Nov 9.
3
Partial splenectomy: A case series and systematic review of the literature.部分脾切除术:病例系列及文献系统综述
Ann Hepatobiliary Pancreat Surg. 2018 May;22(2):116-127. doi: 10.14701/ahbps.2018.22.2.116. Epub 2018 May 30.
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Laparoscopic partial splenectomy for a splenic epidermoid cyst.腹腔镜下脾部分切除术治疗脾表皮样囊肿
Cir Esp. 2017 Dec;95(10):613-615. doi: 10.1016/j.ciresp.2017.03.004. Epub 2017 Apr 11.
7
Laparoscopic subtotal splenectomy.腹腔镜脾次全切除术。
Surg Laparosc Endosc Percutan Tech. 2008 Feb;18(1):94-7. doi: 10.1097/SLE.0b013e31815a889a.
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[Prevention of sepsis in asplenic patients].[无脾患者败血症的预防]
Cir Esp. 2007 May;81(5):247-51. doi: 10.1016/s0009-739x(07)71313-1.
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Laparoscopic partial splenectomy.腹腔镜下部分脾切除术
Surg Endosc. 2007 Jan;21(1):57-60. doi: 10.1007/s00464-006-0124-2. Epub 2006 Oct 9.

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