腹腔镜脾切除术十年经验总结

目的 总结10年来行腹腔镜脾切除术(LS)的临床经验,探讨LS的安全性和有效性.方法 从1996年4月至2006年3月连续进行了135例LS,119例为原发性和继发性脾功能亢进,16例为其他脾疾病,其中48例为巨脾.结果 135例LS中因出血转行开腹脾切除术3例(2.2%),1例术后5 h需作小切口开腹止血,3例术后8～18 h需再次腹腔镜探查和清除脾窝积血.平均手术时间2.3 h,平均失血160 ml,平均术后住院6.5 d.结论 LS安全、有效、切实可行,适用于有脾切除指征的原发性和继发性脾功能亢进或其他脾疾病.     

腹腔镜脾切除术52例的临床分析

自1996～2001年，我们为52例原发性或继发性脾功能亢进和其他脾疾病患者行腹腔镜脾切除术(LS)，现就LS的结果、手术适应证、手术方法和临床应用等问题报告如下。     

腹腔镜下脾脏切除术50例

目的探讨腹腔镜脾脏切除术(laparoscopic splenectomy,LS)治疗继发性脾功能亢进的安全性、有效性。方法2001年7月~2012年6月行LS治疗50例继发性脾功能亢进。经脐孔穿刺建立气腹,腔内直线型切割吻合器(Endo-GIA)离断脾蒂。结果顺利完成50例LS,无一例中转开腹手术。6例发现副脾,术中切除。平均手术时间150 min(70~270min),平均出血量100 ml(50~200 ml)。术后48 h后血小板平均上升250×109/L(200×109/L~350×109/L)。术后住院3~7 d,平均5 d。1例术后12 h因脾窝积血再次腹腔镜探查,清除积血。1例术后出现急性胰腺炎,经治疗痊愈。50例术后随访24~60个月,平均36个月,脾功能亢进无复发。结论 LS治疗继发性脾功能亢进安全、有效。     

腹腔镜脾切除术的临床应用

目的 探讨腹腔镜脾切除术（ＬＳ）的安全性和有效性。方法 从１９９６年４月至１９９９年７月,进行了１３例ＬＳ,其中１２例为原发性或继发性脾功能亢进,１例为脾囊肿,结果 １３例ＬＳ全部完成,无一例需中转行开腹手术,平均手术时间３．２小时,平均失血３８０ｍｌ。１例术后次日需再次腹腔镜探查,清除脾窝积血,平均术后住院６．２天,结论 ＬＳ安全,有效,切实可行,适用于脾体积正常至中度肿大有脾切除指征的血液疾病     

腹腔镜脾切除术52例的手术配合

1991年已报道腹腔镜脾切除术(LS),主要用于治疗ITP等血液疾病[1,2].LS适应症基本与开腹脾切除术相同,但LS较开腹脾切除术有明显的优点:无腹部大切口,损伤少,失血少,减轻了术后疼痛和伤口感染,利于术后恢复,避免术后腹膜炎、肠粘连等并发症的发生,缩短了病人住院时间,减轻了病人经济负担和心理负担.本院自1996～2001年,为52例原发性或继发性脾功能亢进和其他脾疾病患者行LS,效果满意.手术配合体会报告如下.     

腹腔镜脾切除术（附8例报告）

目的 探讨腹腔镜脾切除术的可行性。方法 我院从1996年6月-2001年3月,共施行腹腔镜脾切除术8例,其中乙型肝炎后肝硬化继发脾功能亢进5例、遗传性球形红细胞增多症l例、原发性血小板减少性紫癜l例、脾淋巴管瘤l例。结果 手术成功6例,平均手术时间为4h,平均术中失血350ml,平均术后住院6d,无术后并发症。中转开腹2例。2例同时行腹腔镜胆囊切除术,l例行腹腔镜卵巢囊肿切除术。结论 腹腔镜脾切除术是一种安全可行的脾脏切除方法。     

腹腔镜脾切除术中的操作与显露

目的　探讨腹腔镜脾切除术 (LaparoscopicSplenectomy ,LS)手术操作和术野显露。　方法回顾分析 1999年 6月以来 11例LS临床资料 ,包括 1例肝硬化脾功能亢进和 10例原发性血小板减少性紫癜 (IdiopathicThrombocytopenicPurpura ,ITP)。　结果　 9例获得成功 ,其中 6例采取仰卧位 ,手术时间平均 3 5小时 ,术中出血平均 2 0 0ml;1例采取右侧卧位 ,手术时间 4小时 ,术中出血 80ml;2例采取右侧斜卧位 ,手术时间分别为 2 5小时和 3 0小时 ,术中出血均为 10 0ml。 1例ITP术后 6小时出现腹腔内出血而再次剖腹手术 ,2例ITP中转开腹。　结论　脾周韧带及组织的良好显露与分离和脾蒂的成功控制是腹腔镜脾切除术成功的关键。     

完全腹腔镜下脾切除术的临床应用(附63例报道)

目的:探讨腹腔镜脾切除术(laparoscopic splenectomy,LS)的临床应用。方法:我们2001年至2008年共实施LS63例,其中特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)42例,门脉高压继发性脾功能亢进11例,白血病5例。结果:全部病例均在腹腔镜下完成手术,无中转开腹。平均手术时间140min,术中平均失血120ml,术后出血1例,每天约20ml,保守治疗12d后痊愈;术后胃漏1例,手术缝合及引流后痊愈。术后平均住院6d。结论:LS具有创伤小,患者恢复快、痛苦轻和住院时间短等优点,适用于脾脏体积正常至中度增大的有切脾指征的各类患者。     

超声刀在腹腔镜脾脏切除术中的应用

自从 1991年腹腔镜脾脏切除术 (LS)应用于临床以来〔1〕,由于术后胃肠功能恢复快 ,疼痛轻 ,并发症少 ,死亡率低 ,因此适用于患血液疾病需行脾切除者〔2〕。我们从 2 0 0 0年 7月至 2 0 0 2年 5月使用超声刀为 2 0例原发性脾功能亢进的病人行LS治疗 ,取得成功。临床资料1.一般资料 :本组男性 5例 ,女性 15例。年龄13～ 5 5岁 ,平均 32岁。术前诊断分别为 :原发性血小板减少性紫癜 (ITP) 14例 ,自体免疫性溶血性贫血 (AIHA) 4例 ,Evan综合征 2例。本组 14例脾体积正常或轻度肿大 ,1例脾体积缩小 ,5例脾明显肿大。 3例有妇科手术史。本组…     

腹腔镜脾切除及门奇静脉断流术10例报告

目的探讨腹腔镜脾切除和门奇静脉断流术的手术方法、安全性和有效性.方法从2000年1月至2005年7月为10例肝硬化门静脉高压症继发性脾功能亢进和上消化道出血患者进行了完全腹腔下脾切除和门奇静脉断流术,其中2例加做上腹小切口、管形吻合器食管下段横断和吻合术.结果本组10例腹腔镜脾切除和门奇静脉断流术全部完成,无1例需中转开腹手术.手术时间4.5～5.5 h,出血量100～400ml,术后住院8～15 d.结论腹腔镜脾切除和门奇静脉断流术在技术上是切实可行的,对机体创伤小、疗效确定.     

Are the favorable outcomes of splenectomy predictable inpatients with idiopathic thrombocytopenic purpura (ITP)?

BACKGROUND: Historically, splenectomy has been an accepted procedure in the management of immune thrombocytopenic purpura (ITP). However, it is also true that the response to splenectomy in patients with ITP seems to be unpredictable. Therefore, the purpose of this study was to identify clinical variables that might predict a favorable response to splenectomy in patients with ITP. METHODS: Data were collected retrospectively for 40 adult patients with ITP who underwent laparoscopic (LS) and open (OS) splenectomy at Emory University Hospital between 1992 and 1999. Demographics and outcomes were recorded. Age, sex, disease duration, comorbidities (ASA > 2), previous response to steroids and/or other medications, and preoperative platelet count were analyzed by univariate (t-test, Fisher's exact test) and multivariate statistical methods. RESULTS: Of the 20 patients in each group, improved platelet counts were noted in 18 patients (90%) in the LS group and 20 patients (100%) in the OS group. Follow-up (16 +/- 3 months) was obtained in 19 LS patients (95%) and 16 OS patients (80%), with 84% and 87.5% sustained response rates, respectively. After univariate analysis, two variables (age and disease duration) were found to be significantly related to the outcome of splenectomy (p 相似文献   

Trends in laparoscopic splenectomy for massive splenomegaly

HYPOTHESIS: During the past 10 years, expertise with minimally invasive techniques has grown, leading to an increase in successful laparoscopic splenectomy (LS) even in the setting of massive and supramassive spleens. DESIGN: Retrospective series of patients who underwent splenectomy from November 1, 1995, to August 31, 2005. SETTING: Academic tertiary care center. PATIENTS: Adult patients who underwent elective splenectomy as their primary procedure (n = 111). MAIN OUTCOME MEASURES: Demographics, spleen size and weight, conversion from LS to open splenectomy, postoperative length of stay, and perioperative complications and mortality. Massive splenomegaly was defined as the spleen having a craniocaudal length greater than 17 cm or weight more than 600 g, and supramassive splenomegaly was defined as the spleen having a craniocaudal length greater than 22 cm or weight more than 1600 g. RESULTS: Eighty-five (77%) of the 111 patients underwent LS. Of these 85 patients, 25 (29%) had massive or supramassive spleens. These accounted for 40% of LSs performed in 2004 and 50% in 2005. Despite this increase in giant spleens, the conversion rate for massive or supramassive spleens has declined from 33% prior to 1999 to 0% in 2004 and 2005. Since January 2004 at our institution, all of the massive or supramassive spleens have been removed with a laparoscopic approach. Patients with massive or supramassive spleens who underwent LS had no reoperations for bleeding or deaths and had a significantly shorter postoperative length of stay (mean postoperative length of stay, 3.8 days for patients who underwent LS vs 9.0 days for patients who underwent open splenectomy; P<.001). CONCLUSIONS: Despite conflicting reports regarding the safety of LS for massive splenomegaly, our data indicate that with increasing institutional experience, the laparoscopic approach is safe, shortens the length of stay, and improves mortality.     

Outcome of laparoscopic splenectomy with preoperative splenic artery embolization for massive splenomegaly

Background  

Laparoscopic splenectomy (LS) has become a safe and feasible procedure for cases involving spleens of normal size. Only a few publications report on the outcome of LS with preoperative splenic artery embolization (SAE) for massive splenomegaly. The authors present their experience in patients with massive splenomegaly who underwent laparoscopic-assisted splenectomy (LAS) or hand-assisted laparoscopic splenectomy (HALS) following SAE.     

Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura: Outcome and Long-term Results

The technical feasibility of laparoscopic splenectomy (LS) has been recently established. However, data regarding the efficacy of the procedure with long-term follow-up of patients with idiopathic thrombocytopenic purpura (ITP) are scarce. The objective of this study was to determine retrospectively the immediate efficacy and the long-term results of a standardized laparoscopic procedure applied to patients with ITP refractory to medical treatment. Laparoscopic splenectomy was performed in 35 patients for ITP between May 1993 and May 1998. The lateral approach was used in the last 27 patients. Data were recorded retrospectively on that group. Twenty-six patients (96%) underwent successful LS. Mean operative time for the laparoscopic procedure was 90 minutes. There were no postoperative deaths. Postoperative complications developed in three patients. Thrombocytopenia resolved after surgery in 93% of patients, but 7 patients (25%) experienced relapse during a mean 28-month follow-up. At present no patient needs medical therapy to maintain a normal platelet count. Laparoscopic splenectomy is feasible and safe in patients with ITP. Long-term results of LS for ITP are comparable to those achieved with open splenectomy.     

Laparoscopic versus open splenectomy in children

BACKGROUND: The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. METHODS: The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively. RESULTS: Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwent LS for the following indications: ITP (n = 20), sickle cell disease or thalassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic disorders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) underwent OS during the same time period for ITP (n = 4), sickle cell disease or thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indications (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS cases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the spleen did not fit in the bag. No other cases were converted. Median estimated blood loss was 50 mL for both the LS and OS groups. The only intraoperative complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter length of hospital stay (1.8 +/- 1 versus 4.0 +/- 1 day, P = .0001). Total hospital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated causes. Two LS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically. CONCLUSION: LS in children can be performed safely with a low conversion rate (2.9%) and is associated with a shorter hospital stay and comparable total hospital cost when compared with OS.     

腹腔镜脾切除与开腹脾切除的疗效观察

目的探讨腹腔镜脾切除治疗非外伤性脾肿大的可行性与安全性。方法选取我院2009年1月至2013年6月因非外伤性脾肿大而进行脾切除的患者40例,其中22例行腹腔镜脾切除术为腹腔镜(LS)组,18例行传统开腹的脾切除术作为开腹组(OS),观察两组围手术期的相关指标,并进行对比分析。结果LS组中2例(9.1%)患者因术中出血而中转开腹,6例患者于腔镜下同时行门奇静脉断流术,4例患者于腔镜下同时行胆囊切除术。OS组中7例患者同时行门奇静脉断流术,3例患者同时行胆囊切除术。两组患者的脾重量、体积以及长度均无统计学意义(P值>0.05)。LS组的平均手术时间长于OS组,但LS组术中失血量和术中输血的例数均也少于OS组,差异均有统计学意义(P值<0.05)。LS组术后平均住院时间为7.6±1.8(d),小于OS组的10.1±2.1(d),差异有统计学意义(P值<0.01)。LS组术后并发症率为18.2%,要低于OS组的38.9%(P<0.05),两组均无死亡病例。结论腹腔镜脾切除术治疗非外伤性脾肿大是安全可行的。     

Laparoscopic splenectomy in children--a multicenter experience

Purpose

Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a multicenter experience of 159 laparoscopic splenectomies.

Methods

Records of 159 children, who underwent LS in 3 pediatric surgery centers between 1996 and 2006, were reviewed retrospectively with a special questionnaire. The indication for splenectomy were hematologic disorders (147), esophageal varices (6), splenic cyst (5), and tumor of the tail of the pancreas (1). The LS was performed using standard laparoscopic technique and instrumentation.

Results

There were 75 boys and 84 girls. Median age was 12.5 years (range, 2-19.4 years). Laparoscopic splenectomy alone was performed in 118 cases and LS with cholecystectomy or cholecystotomy in 36. In 5 cases, LS was performed together with fundoplication. Eight LS required conversion to an open procedure for following reasons: severe bleeding (3), massive splenomegaly (1), anatomical (2), and technical aspects (2). Accessory spleens were identified in 20 cases (12.6%). There was no mortality. Complications consisted of 8 conversions and postoperatively of mild generalized infection in 3 children and abdominal bleeding that resulted in re-laparoscopy in 1 case.

Conclusions

Laparoscopic splenectomy can be safely and effectively performed in children.