经腹腔镜脾切除治疗重度以上脾肿大的疗效观察  

A search of efficacy with laparoscopic splenectomy for massive and supramassive spleens

作　　者：张杰[1] 周少波[1] 褚亮[1] 

机构地区：[1]蚌埠医学院第二附属医院普外一区,蚌埠233040

出　　处：《中华腔镜外科杂志（电子版）》2012年第3期38-42,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨重度以上脾肿大经腹腔镜脾切除的安全性和有效性。方法对1995年1月至2011年9月间行脾切除术的患者进行回顾性调查。定义脾上下极长度≥17cm或重量≥600g为重度脾肿大,脾上下极长度≥22cm或重量≥1600g为巨脾。结果行腹腔镜脾切除术22例,开腹脾切除术21例,其中巨脾患者行腹腔镜脾切除术与开腹脾切除术分别为12例和14例。与开腹脾切除术相比,巨脾患者腹腔镜脾切除术具有术中出血少(308mlvs400ml,P=0.24),术后住院时间短(3dvs4.5d,P=0.054)和相似的并发症发生率(17%vs14%),但手术时间较长(195minvs105min,P=0.008),中转开腹率25%。所有行开腹脾切除术患者中再手术2例,1例死亡。结论重度以上脾肿大经腹腔镜脾切除手术预后优于开腹手术。经腹腔镜脾切除术与手助腹腔镜脾切除预后相当。Objective To evaluate the safety and efficacy of laparoscopic splenectomy for massive and supramassive splenomegaly. Methods A retrospective review of patients was conducted for splenectomy occurring from Jan 1995 to Sep 2011. Massive and supramassive spleens were defined as craniocaudad length ≥ 17 cm or weight ≥ 600 g and craniocaudad length ≥ 22 cm or weight ≥ 1600 g,respectively. Results Laparoscopic splenectomy was done for 22 and open splenectomy for 21 patients, of which 12 and 14 were supramassive. Comparing with open splenectomy, laparoscopic splenectomy for supramassive spleens was associated with lower blood loss( 308 ml vs 400 ml,P = 0.24 ), shorter length of postoperative stay ( 3 d vs 4.5 d,P = 0.054 ), and similar morbidity ( 17 % vs 14 % ). But operative times were longer for laparoscopic splenectomy ( 195 min vs 105 min,P = 0.008 ), while the conversion rate was 25 % . Two reoperations and 1 death occurred with all open splenectomy. Conclusions In cases of massive and supramassive splenomegaly, better outcomes are accomplished with laparoscopic splenectomy than open splenectomy, and are comparable to hand-assisted laparoscopic splenectomy.

关 键 词：腹腔镜脾切除术 重度脾肿大 巨脾 手助腹腔镜脾切除术 

分 类 号：R657.6[医药卫生—外科学]