Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function

BACKGROUND The liver hemodynamic changes caused by portal hypertension(PH)are closely related to various complications such as gastroesophageal varices and portosystemic shunts,which may lead to adverse clinical outcomes in these patients,so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications.AIM To study the clinical efficacy of total laparoscopic splenectomy(TLS)for PH and its influence on hepatic hemodynamics and liver function.METHODS Among the 199 PH patients selected from October 2016 to October 2020,100 patients[observation group(OG)]were treated with TLS,while the remaining 99[reference group(RG)]were treated with open splenectomy(OS).We observed and compared the clinical efficacy,operation indexes[operative time(OT)and intraoperative bleeding volume],safety(intraperitoneal hemorrhage,ascitic fluid infection,eating disorders,liver insufficiency,and perioperative death),hepatic hemodynamics(diameter,velocity,and flow volume of the portal vein system),and liver function[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST),and serum total bilirubin(TBil)]of the two groups.RESULTS The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG.Additionally,the overall response rate,postoperative complications rate,and liver function indexes(ALT,AST,and TBil)did not differ significantly between the OG and RG.The hepatic hemodynamics statistics showed that the pre-and postoperative blood vessel diameters in the two cohorts did not differ statistically.Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values,there were no significant inter-group differences.CONCLUSION TLS contributes to comparable clinical efficacy,safety,hepatic hemodynamics,and liver function as those of OS in treating PH,with a longer OT but lesser intraoperative blood loss.

Splenic lymphangioma masquerading as splenic abscess managed by laparoscopic splenectomy: A case report

BACKGROUND Primary benign splenic tumours are unique and account for<0.007%of all tumours identified during surgery and autopsy.Splenic lymphangiomas are rarely seen in adults.Splenic lymphangiomas may be asymptomatic,or may present with upper left abdominal pain,splenomegaly,hypersplenism,or splenic rupture with haemorrhagic shock.The clinical and radiological features of these lesions are not specific.This case report serves to remind the clinician to consider the rare but important differential diagnosis of splenic lymphangioma while treating splenic lesions.CASE SUMMARY We report a case of splenic lymphangioma in a 22-year-old woman who presented with left upper quadrant abdominal pain for three months.Initial investigations were unremarkable;however,computed tomography later revealed multiple splenic micro-abscesses.The patient underwent laparoscopic splenectomy,and histopathological examination revealed splenic lymphangioma.The patient was discharged on postoperative day three.One month after surgery,the abdominal pain resolved completely,with no new complaints.Splenic lymphangiomas present clinically as splenomegaly or left upper quadrant abdominal pain;prompt intervention is necessary for avoiding complications.CONCLUSION This case report concludes that splenic lymphangiomas should be considered in the differential diagnosis of splenomegaly or left upper quadrant pain,even in adults,because they are amenable to curative treatment.Delays in surgical intervention may lead to severe complications,such as infection,rupture,and hemorrhage.Such lesions can be safely managed with laparoscopy,involving less postoperative pain and early patient discharge with excellent cosmetic outcomes.

Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients:a meta-analysis

BACKGROUND： Laparoscopic splenectomy is considered the gold standard for resecting normal-to-moderately bigger spleens in benign conditions, and in addition could be tried for patients with malignant splenic disorders. However, the safety of laparoscopic splenectomy in patients with hyper- splenism is not well-known. This study aimed to investigate the efficacy and safety of laparoscopic splenectomy for pa- tients with hypersplenism secondary to liver cirrhosis by com- paring with the open splenectomy.

Partial splenectomy using a laparoscopic bipolar radiofrequency device:A case report

We report a 51-year-old female patient with a solitary lymphangioma located in the upper splenic pole which was managed successfully with laparoscopic partial splenectomy.Surgery lasted 170 min and did not require blood transfusions.The patient recovered well post-operatively and was asymptomatic at the 3-mo follow-up.She had a normal platelet count and no recurrence on ultrasonography or computed tomography.Laparoscopic partial splenectomy is a safe,minimally invasive technique for the treatment of solitary splenic lymphangiomas in the splenic pole.We performed the procedure using the HabibTM 4X device.This laparoscopic bipolar radiofrequency device ensured a "bloodless" splenic parenchymal resection.

Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: A metaanalysis

BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its advantages.AIM To evaluate the efficacy and advantages of HALS for splenomegaly.METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane,Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from16 trials who met the inclusion criteria were selected.RESULTS In pure splenectomy, blood loss volume(P < 0.001) and conversion rate(P =0.008) were significantly lower in the HALS group than in the LS group.Conversely, for splenomegaly, the operative time(P = 0.04) was shorter and blood loss volume(P < 0.001) and conversion rate(P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach(DUS), the operative time(P = 0.04) was significantly shorter and blood loss volume(P < 0.001) andconversion rate(P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.

Laparoscopic splenectomy for primary immune thrombocytopenia:Current status and challenges

Primary immune thrombocytopenia(ITP) is an immunemediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy(LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting longterm outcome of splenectomy which can help make the decision of operation.

Laparoscopic splenectomy for splenic hamartoma:Case management and clinical consequences

Splenic hamartoma is a rare benign tumor,and although minimally invasive surgery may be suitable for this condition,there have only been 2 previous reports of laparoscopic surgery.Here we report the third case of splenic hamartoma managed by laparoscopic splenectomy.A 37-year-old male was incidentally diagnosed by abdominal ultrasonography with a hypoechoic mass measuring 2.5 cm × 2.4 cm in the spleen.Color Doppler sonography showed multiple flow signals within the mass and contrast-enhanced computed tomography revealed strong enhancement of the lesion.On T1-and T2-weighted magnetic resonance images,the splenic mass was demonstrated as isointense and hyperintense respectively.Although a malignant tumor could not be ruled out,a hand-assisted laparoscopic splenectomy was performed because the splenic mass was limited in size and had not invaded adjacent organs.The pathological diagnosis was splenic hamartoma.The postoperative course was uneventful and the patient was discharged by the seventh postoperative day.Although splenic hamartomas have some specific imaging features,more reports and analyses of these cases are required to increase the reliability of the diagnosis and management.Hand-assisted laparoscopic splenectomy may play a pivotal role in the postoperative diagnosis and management of this condition.

Laparoscopic versus Traditional Open Splenectomy for Hepatocellular Carcinoma with Hypersplenism

This study aimed to examine the efficacy of the laparoscopic vs. traditional open splenectomy for hepatocellular carcinoma（HCC） with hypersplenism. Between 2002 and 2013, 51 Chinese HCC patients with hypersplenism underwent either simultaneous laparoscopic splenectomy plus anticancer therapies（Lap-S＆A）（n=25） or traditional open splenectomy plus anti-cancer therapies（TOS＆A）（n=26）. The outcomes were reviewed during and after the operation. Anti-cancer therapies for HCC included laparoscopic hepatectomy（LH） and laparoscopic microwave ablation（LMA）. The results showed that there was no significant difference in the operating time between the two groups, but the blood loss and blood transfusion were less, pain intensity after surgery was weaker, the time to first bowel movement, time to the first flatus and postoperative hospital stay were shorter, and the postoperative complication rate and the readmission rate were lower in the Lap-S＆A group than in the TO-S＆A group. Two patients in the Lap-S＆A group and one patient in the TO-S＆A group died 30 days after surgery. However, no significant difference in the mortality rate was noted between the two groups. It was concluded that simultaneous Lap-S＆A holds the advantages of more extensive indications, lower complication incidence and less operative expenditure than conventional open approach and it is a feasible and safe approach for HCC with hypersplenism.

Laparoscopic splenectomy for histiocytic sarcoma of the spleen

Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her postoperative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.

Laparoscopic Partial Splenectomy for Giant Hemangioma Misdiagnosed as Splenic Cyst:a Case Report

ALTHOUGH unusual,hemangioma is the most common type of primary splenic neoplasm.1 Usually,splenic hemangioma appears as solid mass,but sometimes it presents cystic com-

Laparoscopic splenectomy:Current concepts

Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.

Laparoscopic splenectomy for treatment of splenic marginal zone lymphoma

AIM: To investigate the short-term and long-term ef-ficacy and safety of laparoscopic splenectomy (LS) for treatment of splenic marginal zone lymphoma (SMZL). METHODS: A total of 18 continuous patients who were diagnosed with SMZL and underwent LS in our department from 2008 to 2012 were reviewed. The perioperative variables and long-term follow-up were evaluated. To evaluate the efficacy and safety of this procedure better, we also included 34 patients with liver cirrhosis who underwent LS, 49 patients with immune thrombocytopenia (ITP) who underwent LS, and 20 patients with SMZL who underwent open splenectomy (OS). The results observed in the different groups were compared.RESULTS: No differences were found in the sex and Child-Pugh class of the patients in SMZL-LS, SMZL-OS, ITP, and liver cirrhosis groups. The splenic length of the patients in the SMZL-LS group was similar to that in the SMZL-OS and liver cirrhosis groups but significantly longer than in the ITP group. The SMZL-LS group had a significantly longer operating time compared with the SMZL-OS, ITP, and liver cirrhosis groups, and the SMZL-LS group exhibited significantly less blood loss compared with the SMZL-OS group. No difference was found in the length of the postoperative hospital stay between the SMZL-LS, SMZL-OS, ITP, and liver cirrhosis-LS groups. After surgery, 6 (33.3%) SMZL-LS patients suffered slight complications. During mean fol-low-up periods of 13.6 and 12.8 mo, one patient from the SMZL-LS group and two from the SMZL-OS group died as a result of metastasis after surgery. None of the ITP and liver cirrhosis patients died. CONCLUSION: LS should be considered a feasible and safe procedure for treatment of SMZL in an effort to improve the treatment options and survival of patients.

Reaching proficiency in laparoscopic splenectomy

AIM:To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.METHODS:All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n=33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.CONCLUSION: Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.

Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents

BACKGROUND In order to avoid consequences of total splenectomy,partial splenectomy(PS)is increasingly reported.The purpose of this study was to compare perioperative outcomes of laparoscopic PS(LPS)and open PS(OPS)in children and adolescents.AIM To compare perioperative outcomes of patients with LPS and OPS.METHODS After institutional review board approval,a total of 26 patients that underwent LPS or OPS between January 2008 and July 2018 were identified from the database of our tertiary referral center.In total,10 patients had LPS,and 16 patients underwent OPS.Blood loss was calculated by Mercuriali’s formula.Pain scores,analgesic requirements and complications were assessed.The Wilcoxon rank sum test was used for comparison.To compare categorical variables,Fisher’s exact test was applied.RESULTS LPS was performed in 10 patients;16 patients had OPS.Demographics(except for body mass index and duration of follow-up),indicating primary disease,preoperative spleen size and postoperative spleen volume,perioperative hematological parameters,postoperative pain scores,analgesic requirements,adverse events according to the Clavien-Dindo classification and the comprehensive complication index,median time from operation to initiation of feeds,median time from operation to full feeds,median time from operation to mobilization and median length of hospital stay did not differ between LPS and OPS.Median(range)operative time(min)was longer in LPS compared to the OPS group[185(135-298)vs 144(112-270),respectively;P=0.048].Calculated perioperative blood loss(mL of red blood cell count)was higher in the LPS group compared to OPS[87(-45-777)vs-37(-114-553),respectively;P=0.039].CONCLUSION This is the first study that compared outcomes of LPS and OPS.Both operative approaches had comparable perioperative outcomes.LPS appears to be a viable alternative to OPS.

Laparoscopic distal pancreatectomy: Up-to-date and literature review

Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffu- sion. Additional researches are necessary to determine the best technique to improve the procedure results.

Consecutive laparoscopic gallbladder and spleen resections in cirrhotic patients

AIM:To evaluate the feasibility,safety,and effectiveness of consecutive laparoscopic cholecystectomy(LC)plus splenectomy(LS)in liver cirrhosis patients.METHODS:From 2003 to 2013,17(group 1)patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS,while 58(group 2)patients with liver cirrhosis and hypersplenism received LS alone.An additional 14(group 3)patients who received traditional open procedures during the same period were included as controls.Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative,intraoperative and postoperative features.Differences between the three groups were assessed by statistical analysis.RESULTS:The three groups showed no significant differences in the demographic characteristics or preoperative status.However,the patients treated with LC and LS required significantly longer operative time,shorter postoperative stay as well as shorter time of return to the first oral intake,and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures(group 1 vs group 3,P<0.05 for all).The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone(group 1 vs group 2).All patients showed significant improvements in the haematological responses(preoperative period vs postoperative period,P<0.05 for all).None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge,while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.CONCLUSION:Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism,especially for those with Child-Pugh A and B.

Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

Because distal pancreatectomy(DP)has no reconstructive steps and less frequent vascular involvement,it is thought to be the easier counterpart of pancreaticoduodenectomy.This procedure has a high surgical risk and the overall incidences of perioperative morbidity(mainly pancreatic fistula),and mortality are still high,in addition to the challenges that accompany delayed access to adjuvant therapies(if any)and prolonged impairment of daily activities.Moreover,surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes.From this perspective,new surgical approaches,and aggressive techniques,such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection,could lead to improved survival in those affected by more locally advanced tumors.Conversely,minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress.The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications,length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy.Because a dedicated multidisciplinary team is crucial to pancreatic surgery,hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign,borderline,and malignant diseases of the pancreas.The purpose of this review is to examine the state of the art in distal pancreatectomies,with a special focus on minimally invasive approaches and oncological-directed techniques.The widespread reproducibility,cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

基于CT肝细胞外体积分数对门静脉高压症术后再出血的预测价值

目的:探讨CT肝细胞外体积分数(ECV)预测肝硬化门静脉高压症术后胃底食管静脉再出血(EGVR)的价值。方法:回顾性分析154例门静脉高压患者行经腹腔镜脾切除联合贲门周围血管离断术(LSD)的患者术前CT图像及实验室检查资料。经过术后一年的随访,将患者分为再出血组和非再出血组。选取平扫及延迟期图像,分别测量肝脏、脾脏及主动脉的增强前后CT值,计算肝脏及脾脏细胞外体积分数(ECV)。比较ECV在再出血与非再出血组之间差异。通过多因素分析筛选再出血相关危险因素。构建ECV及联合参数模型,使用受试者操作特征曲线下面积(AUC)评估构建模型的预测效能。结果:LSD术后再出血组肝脏ECV值显著低于非再出血组(32.0%±4.5%vs.39.9%±4.0%,P<0.0001)。再出血组脾脏ECV低于非再出血组(42.1%±7.5%vs.46.2%±6.8%,P=0.002)。凝血酶原时间(PT)、纤维蛋白原(FIB)、肝脏ECV是患者发生术后再出血的独立危险因素,其再出血的诊断效能AUC值分别为0.711、0.724、0.923。联合模型(PT+FIB+肝脏ECV)的AUC值为0.963,与单独肝脏ECV模型差异无统计学意义。结论:肝脏ECV能有效预测门静脉高压患者LSD术后再出血的发生,优于PT和FIB的诊断效能。

腹腔镜脾部分切除术在脾良性占位性病变手术治疗中的疗效分析

目的评估腹腔镜脾部分切除术(laparoscopic partial splenectomy,LPS)在脾良性占位性病变手术治疗中的效果及安全性。方法分析华中科技大学同济医学院附属协和医院自2018年1月至2023年7月收治的85例脾良性占位性病变病人的临床资料,根据手术方式分为两组,25例行LPS的病人为LPS组,60例行腹腔镜全脾切除术(laparoscopic total splenectomy,LTS)的病人为LTS组。统计比较两组术前、术中、术后指标以及并发症(腹腔积液、感染、静脉血栓形成、血小板增多症等)发生率。结果两组病人均顺利完成手术。LPS组与LTS组比较,术后引流时间[(4.6±1.6)d比(5.9±1.6)d]、术后通气时间[(1.4±0.5)d比(1.9±0.8)d]、术后活动时间[(2.6±0.5)d比(3.1±0.8)d]及术后住院时间[(6.3±1.5)d比(7.8±3.1)d]均缩短,且术后第1、3天白细胞计数[(10.2±2.1)×10^(9)/L比(14.7±4.1)×10^(9)/L、(9.5±3.3)×10^(9)/L比(13.3±3.8)×10^(9)/L]及术后第1、3天血小板计数[(172.8±57.9)×10^(9)/L比(203.0±61.3)×10^(9)/L、(210.1±112.5)×10^(9)/L比(298.0±125.9)×10^(9)/L]LPS组均低于LTS组,差异均有统计学意义(均P<0.05);但两组的手术时间、术中出血量、术后引流量、红细胞计数、血红蛋白水平及白蛋白水平比较差异均无统计学意义(均P>0.05)。此外,LPS组术后并发症发生率显著低于LTS组[4.0%(1/25)比30.0%(18/60)],差异有统计学意义(χ^(2)=5.457,P<0.05)。结论LPS是一种疗效确切、安全可行的手术方式,在脾良性占位性病变的临床诊疗中具有重要价值,建议在有条件的医疗中心进行推广。

脾切除术后胰瘘影响因素分析及预测模型构建

目的探讨脾切除术病人术后发生胰瘘的影响因素,并构建预测模型。方法回顾性分析第九〇九医院(厦门大学附属东南医院)2019年6月至2022年6月收治的89例行脾切除术病人临床资料,根据术后是否发生胰瘘分为胰瘘组(13例)和无胰瘘组(76例),采用单因素和logistic多因素回归分析术后胰瘘发生独立影响因素,并建立风险预测模型,绘制受试者操作特征(receiver operator characteristic,ROC)曲线,计算曲线下面积(area under the curve,AUC),评估该模型对胰瘘发生的预测价值,分析胰瘘病人的预后情况。结果单因素分析结果发现体重指数(body mass index,BMI)≥27 kg/m^(2)、急诊手术、脾破裂、使用切割闭合器、高年资主治医师主刀手术、脾脏长度≥15 cm、术中暴露不佳的病人胰瘘发生率更高(P<0.05);多因素回归分析结果发现胰瘘独立影响因素为:BMI≥27 kg/m^(2)[HR=17.194,95%CI(2.151,137.407),P<0.05];脾破裂[HR=7.551,95%CI(1.891,64.017),P<0.05];高年资主治医师主刀手术[HR=7.250,95%C(I 1.888,59.188),P<0.05];术中暴露不佳[HR=13.803,95%CI(1.515,125.749),P<0.05]。构建胰瘘风险模型为Logit(P)=-18.155+2.845×X_(1)+2.022×X_(2)+1.981×X_(3)+2.625×X_(4)(X_(1)为BMI、X_(2)为脾破裂、X_(3)为主刀医师资历、X_(4)为术中暴露不佳)。ROC曲线分析发现该模型预测胰瘘AUC为0.943,灵敏度为0.884,特异度为0.859,95%C(I 0.875,1.000),P<0.05。13例胰瘘病人中,8例为生化漏、5例为B级胰瘘,保守治疗后均好转。结论肥胖、脾破裂、主刀医师资历和术中暴露不佳是脾切除术后胰瘘发生的独立影响因素,根据多因素分析结果构建风险预测模型对术后胰瘘发生具有较好的预测价值。