腹腔镜脾切除术脾脏大小极限的争议与手术策略  

Surgical strategy and controversy about upper limit of splenic size for laparoscopic splenectomy

作　　者：姜洪池[1] 李丹[1] Jiang Hongchi Li Dan.(Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China)

机构地区：[1]哈尔滨医科大学附属第一医院普通外科,150001

出　　处：《中华消化外科杂志》2017年第8期777-781,共5页Chinese Journal of Digestive Surgery

基　　金：美国中华医学基金会项目（08-894）

摘　　要：腹腔镜脾切除术（LS）因其微创手术的显著优越性而被认可为正常大小或轻中度肿大脾脏切除术的标准手术方式。随着腹腔镜技术的提高，巨脾是LS禁忌证的观点正在不断被挑战。但目前针对这一问题的争议颇大：（1）脾肿大和巨脾的概念不明确。（2）虽然针对巨脾LS面临的种种障碍都有相应的改良措施以促进手术安全施行，但是对于巨脾行LS的可行性、安全性以及预后效果还存在巨大争议。（3）无论是支持还是反对巨脾LS，问题的关键都在于能成功施行LS脾脏大小的上限存在很大争议。鉴于此，笔者推荐将我国的脾肿大“三度法”改为“四度法”，以利于指导手术方式的选择。Laparoscopic splenectomy （LS） is consi dered as the standard approach for patients with normal-sized or moderately enlarged spleens because of advantages of minimal invasion. With the improvement of laparoscopic techniques, the previous concept that massive splenomegaly （MS） is a contraindication to LS is being challenged. Nevertheless, there is still a tremendous controversy over this issue. （1） Splenomegaly and MS are not clearly defined. （2） The feasibility, safety and postoperative outcomes of LS for MS are fiercely debated despite much improvement of LS for MS. （3） Whether supporting or opposing LS for MS, the core problem that the upper limit of splenic size can be in accord with a requirement of LS is controversial. Taking these issues into account, authors recommended that the splenomegaly should be divided into ＂four degrees＂ rather than ＂three degrees＂ for the sake of guiding the choice of surgery.

关 键 词：巨脾 腹腔镜脾切除术 争议 

分 类 号：R657.6[医药卫生—外科学]