Miles W F, Greig J D, Wilson R G, Nixon S J
Department of Surgery, Western General Hospital, Edinburgh, UK.
Br J Surg. 1996 Sep;83(9):1212-4.
The spleen may be removed by a laparoscopic technique, although the benefits and associated morbidity of this approach are unknown. This study reports a series of 28 consecutive patients (15 women; median age 39 (range 17-84) years) considered for laparoscopic splenectomy, because of idiopathic thrombocytopenia in 14, human immunodeficiency virus-related thrombocytopenia in seven, autoimmune haemolytic anaemia in four, lymphoma in two and chronic lymphocytic leukaemia in one. In 23 cases dissection was completed laparoscopically, with the patient in the right lateral position, using a four-cannula technique. Vascular isolation was achieved with an Endo-GIA (powered vascular linear stapler). The spleen was removed by morselation within a retrieval bag (18 patients) or via either a Pfannenstiel or subcostal incision (five). The last 14 procedures have all been completed successfully in a mean operating time of 105 min with discharge from hospital within a median of 3 days. One patient developed a clinically apparent deep venous thrombosis 23 days after operation, for which he required readmission. Elective laparoscopic splenectomy is a feasible although technically demanding operation which may be performed safely and without associated mortality by surgeons experienced in laparoscopic techniques.
脾脏可通过腹腔镜技术切除，尽管这种方法的益处和相关发病率尚不清楚。本研究报告了连续28例患者（15名女性；中位年龄39岁（范围17 - 84岁））因以下原因考虑行腹腔镜脾切除术：14例特发性血小板减少症，7例人类免疫缺陷病毒相关血小板减少症，4例自身免疫性溶血性贫血，2例淋巴瘤，1例慢性淋巴细胞白血病。23例手术通过腹腔镜完成，患者取右侧卧位，采用四套管技术。使用Endo - GIA（动力血管线性缝合器）实现血管分离。脾脏通过在取物袋内切碎取出（18例患者）或经Pfannenstiel切口或肋下切口取出（5例）。最后14例手术均成功完成，平均手术时间为105分钟，中位住院时间为3天。1例患者术后23天出现临床明显的深静脉血栓形成，为此他需要再次入院。选择性腹腔镜脾切除术是一种可行的手术，尽管技术要求较高，经验丰富的腹腔镜技术外科医生可以安全地进行，且无相关死亡率。
