Szold A, Sagi B, Merhav H, Klausner J M
Department of Surgery, Tel Aviv Sourasky Medical Center, Israel.
Surg Endosc. 1998 Aug;12(8):1078-81. doi: 10.1007/s004649900784.
Laparoscopic splenectomy (LS), like other advanced laparoscopic procedures, is still an evolving procedure. The indications for surgery, criteria for patient selection, and operative technique are not yet well defined. We have therefore modified the standard technique for performing LS in an attempt to optimize the procedure.
Over the past 2 years, we have performed LS in 59 patients. The last 43 patients were operated using a standardized technique that we believe to be optimal. It includes the routine use of the right lateral position, operating through three trocars, the mass transection of the splenic vasculature with a vascular endoscopic stapler, and the use of a self-retaining retrieval bag.
The average operating time was 79 min. Average blood loss was 95 cc, and average postoperative hospitalization was 2.3 days. There was one intraoperative complication and one postoperative complication. These results are superior to those we achieved earlier in our own experience, as well as to similar series that have been published recently.
In our experience, the use of this new technique resulted in relatively short procedures with low morbidity. We believe that these results justify the use of LS as the procedure of choice for elective splenectomy in patients with normal or moderately enlarged spleens.
与其他先进的腹腔镜手术一样，腹腔镜脾切除术（LS）仍在不断发展。手术适应症、患者选择标准和手术技术尚未明确界定。因此，我们对进行LS的标准技术进行了改进，以优化该手术。
在过去两年中，我们对59例患者进行了LS。最后43例患者采用了我们认为最佳的标准化技术进行手术。该技术包括常规采用右侧卧位，通过三个套管针进行操作，使用血管内镜吻合器对脾血管进行大块离断，并使用自固定取出袋。
平均手术时间为79分钟。平均失血量为95毫升，平均术后住院时间为2.3天。有1例术中并发症和1例术后并发症。这些结果优于我们之前的经验以及最近发表的类似系列研究的结果。
根据我们的经验，使用这种新技术可使手术相对简短，并发症发生率低。我们认为这些结果证明，对于脾脏正常或中度肿大的患者，LS作为择期脾切除术的首选手术是合理的。
