Huang Cheng, Gao Zhichao, Zhang Yuhang, Ge Lida
Department of Colorectal Surgery, First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China.
Department of Neurosurgery, First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China.
Front Med (Lausanne). 2025 Mar 5;12:1570335. doi: 10.3389/fmed.2025.1570335. eCollection 2025.
Massive splenomegaly is considered to pose a high risk for laparoscopic splenectomy (LS). We report a case of supramassive splenomegaly wherein the patient successfully underwent LS guided by preoperative three-dimensional (3D) reconstruction.
A 35-year-old female had a history of autoimmune hepatitis spanning 4 years, accompanied by progressive splenomegaly. Her spleen had grown to a size of 27.3 cm in diameter, and a consistent decline in her blood cell counts had been noted over the same period. Considering the significant enlargement of the spleen and the technical challenges associated with LS in such instances, a preoperative 3D reconstruction was performed. This 3D model accurately delineated the splenic artery and depicted the positional relationships between the enlarged spleen and nearby organs, thus supporting detailed preoperative planning. Following the surgical route determined in the preoperative planning, 3D assistance enabled the safe ligation of the splenic artery and meticulous separation of the spleen from adjacent tissues. The patient's postoperative recovery was smooth and free from complications.
Meticulous preoperative 3D planning may help overcome technical difficulties and enable successful LS even in patients with supramassive splenomegaly.
巨大脾肿大被认为是腹腔镜脾切除术（LS）的高风险因素。我们报告一例超大脾肿大病例，该患者在术前三维（3D）重建的引导下成功接受了LS。
一名35岁女性有4年自身免疫性肝炎病史，伴有进行性脾肿大。她的脾脏直径已增大至27.3厘米，同期血细胞计数持续下降。鉴于脾脏显著肿大以及此类情况下LS相关的技术挑战，进行了术前3D重建。该3D模型准确描绘了脾动脉，并展示了肿大脾脏与附近器官的位置关系，从而支持了详细的术前规划。按照术前规划确定的手术路径，3D辅助使得脾动脉得以安全结扎，并将脾脏与相邻组织细致分离。患者术后恢复顺利，未出现并发症。
细致的术前3D规划可能有助于克服技术难题，即使对于超大脾肿大患者也能实现LS的成功实施。
