Poulin E C, Mamazza J, Schlachta C M
Department of Surgery, The Wellesley Central Hospital, University of Toronto, 160 Wellesley Street East, Toronto, Ontario, Canada, M4Y 1J3.
Surg Endosc. 1998 Jun;12(6):870-5. doi: 10.1007/s004649900732.
This study assessed preoperative splenic artery embolization before laparoscopic splenectomy.
Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20). An anterior surgical approach was used. After 1994 (group II), embolization was not used for these patients (0/26), and a lateral surgical approach was used. Throughout the study period, all patients with spleens longer than 20 cm had embolization (8/8).
Five complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely because of embolization. In group II, similar results were obtained because of experience and a better surgical approach (i.e., lateral).
Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).
本研究评估了腹腔镜脾切除术前行脾动脉栓塞术的情况。
54例行腹腔镜脾切除术的患者中有26例（48%）采用了术前脾动脉栓塞术。1992年至1994年间，所有脾脏短于20 cm的患者（I组）均采用了该术式，但前两例除外（18/20）。采用前路手术入路。1994年之后（II组），这些患者未行栓塞术（0/26），采用侧路手术入路。在整个研究期间，所有脾脏长于20 cm的患者均行栓塞术（8/8）。
发生了5例并发症，3例与使用小颗粒栓塞材料（微球、明胶海绵粉）有关。在I组中，中转率低于大多数当前系列报道，这主要归因于栓塞术。在II组中，由于经验积累和更好的手术入路（即侧路），也获得了相似的结果。
对于脾脏短于20 cm的患者，术前脾动脉栓塞术并非必要。经验的增加以及主要是侧路手术入路使得手术时间缩短，中转率较低（4%），与研究初期栓塞术联合前路手术入路所达到的中转率相似。对于20至30 cm的脾脏采用栓塞术。中转率较高（17%），且频繁需要输血（83%）。尽管采用了栓塞术，但目前对于脾脏长于30 cm的患者行腹腔镜脾切除术是无效的（100%中转）。
