Flowers J L, Lefor A T, Steers J, Heyman M, Graham S M, Imbembo A L
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Ann Surg. 1996 Jul;224(1):19-28. doi: 10.1097/00000658-199607000-00004.
The authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed.
Laparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant.
Clinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995.
Laparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return of gastrointestinal function occurred in patients 23.1 hours after laparoscopic splenectomy and 76 hours after conversion to open splenectomy (p < 0.05). Mean length of stay was 2.7 days after laparoscopic splenectomy and 6.8 days after conversion to open splenectomy (p < 0.05).
Laparoscopic splenectomy may be performed with efficacy, morbidity, and mortality rates comparable to those of open splenectomy for hematologic diseases, and it appears to retain other patient benefits of laparoscopic surgery.
作者回顾了他们在血液系统疾病患者中开展腹腔镜脾切除术的初步经验。介绍了该技术的疗效、发病率和死亡率，并讨论了其他患者恢复参数。
腹腔镜脾切除术开展得较少，关于其安全性和疗效的数据也很稀缺。原因包括技术难度高、有突然发生严重出血的可能性以及由于手术例数相对有限导致手术经验积累缓慢。对于患者而言，开发一种微创脾切除术形式的潜在益处是巨大的。
对1992年3月至1995年3月期间因血液系统疾病接受择期脾切除术的所有患者进行了临床随访、前瞻性纵向数据库分析和病历回顾。
43例患者尝试进行腹腔镜脾切除术，35例（81%）成功完成。82%的免疫性血小板减少性紫癜患者脾切除术后出现治疗性血小板反应，60%成功接受腹腔镜脾切除术的自身免疫性溶血性贫血患者血细胞比容水平升高。发病率为11.6%（43例患者中的5例），死亡率为4.7%（43例患者中的2例）。腹腔镜脾切除术后患者胃肠功能恢复时间为23.1小时，转为开腹脾切除术后为76小时（p<0.05）。腹腔镜脾切除术后平均住院时间为2.7天，转为开腹脾切除术后为6.8天（p<0.05）。
对于血液系统疾病，腹腔镜脾切除术的疗效、发病率和死亡率与开腹脾切除术相当，并且似乎保留了腹腔镜手术对患者的其他益处。
