Poulin E, Thibault C, Mamazza J, Girotti M, Côté G, Renaud A
Department of Surgery, Hôpital du Saint-Sacrement, Québec, Canada.
Surg Laparosc Endosc. 1993 Dec;3(6):445-50.
We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery--the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most patients were able to resume normal activities < or = 2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r - 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (< 20 cm long) when hematologic indications are present.
我们描述了12例行腹腔镜脾切除术患者的临床过程。2例转为开放手术——系列中的第1例因出血事件，第8例因脾脏长34 cm、解剖困难。其余患者无死亡，围手术期发病率为10%。术后平均住院3.5天（范围2 - 9天），大多数患者在≤2周内能够恢复正常活动。从第3例患者开始使用术前脾动脉栓塞术。该技术包括在近端用弹簧圈栓塞脾脏，在远端用轮廓栓子、可吸收明胶海绵和小弹簧圈栓塞，注意保留至胰尾的血管。术前脾动脉栓塞术导致的手术失血量与脾去血管化百分比之间建立了良好的线性相关性（r = 0.8084）。当有血液学指征时，腹腔镜脾切除术正成为择期切除正常大小或中度肿大脾脏（长度<20 cm）的首选技术。
