腹腔镜巨脾切除的适应证与外科疗效分析

Indication and outcome analysis of laparoscopic splenectomy for massive splenomegaly

目的探讨腹腔镜巨脾切除的适应证与手术疗效。方法对23例腹腔镜巨脾切除病例与53例腹腔镜普通大小脾脏切除及35例开腹巨脾切除病例的手术疗效进行比较。结果本组腹腔镜巨脾切除23例,其中3例同时行腹腔镜巨脾切除伴贲门周围血管离断术,9例同时行胆囊切除术,无手术死亡,其中2例中转开腹。巨脾组和普通组相比,手术时间长[(142±29)min vs (92±18)min]和术中出血量多[(540±90)ml vs (210±80)ml](P均<0.05),术后住院时间、腹腔引流置管时间、术后并发症和中转开腹率方面没有差异。巨脾组与开腹组相比,术后腹腔镜引流置管时间[(4.7±0.5)dvs(7.7±0.9)d]和术后住院时间[(5.7±0.5)d vs (8.4±0.9)d]短,术后并发症少(4.3% vs 11.4%)(P均<0.05),但术中出血和手术时间差异没有统计学意义。结论腹腔镜巨脾切除术安全可行,近期疗效良好。

Objective To explore the indication and outcome of laparoscopie spleneetomy （LS） for massive splenomegaly. Methods The data from patients with LS for massive splenomegaly were analyzed retrospectively, and the outcome of LS for massive splenomegaly were compared witb those of LS for normal splenomegaly and open splenectomy for massive splenomegaly. Results Twenty-three patients undergone LS for massive splenomegaly and 3 patients combined with pericardial devascularization, 2 patients converted to open splenectomy, there was no operative death case in LS. Compared with LS for normal splenomegaly, the operation time [（142±29） rain vs （92±18）min] was longer and blood loss [（540±90）ml vs （210±80）ml] was more （P〈0.05）, but the hospitalization period, abdominal drainage period, post-operative complication rate and conversion rate had no statistic difference. Compared with open spleneetomy for massive splenomegaly, the abdominal drainage period [（4.7±0.5）d vs （7.7±0.9）d] and hospital stay period [（5.7±0.5）d vs（8.4±0.9）d] were shorter （P〈0.05）, the post-operative complication rate （4.3% vs 11.4%） was lower （P〈0.05）, but the operation time and blood loss had no statistic difference. Conclusion Laparoseopic spleneetomy for massive splenomegaly is safe and feasible.