Partial splenectomy in non-traumatic benign lesions of the spleen

Partial splenectomy was performed in a patient with cystic lymphangioma and two patients with splenic pseudo-cysts, one of traumatic origin and the other necrotic following infarct. Anatomical features on which this operation is based, together with the technique employed, are exposed and the criteria of efficacy examined. Partial splenectomy was performed to reduce splenomegaly complicated with hypersplenism, and is also applicable for exeresis of cystic and pseudo-cystic splenic lesions. These indications are worthy of more extensive application in young adults.     

脾部分切除治疗脾良性肿瘤(附16例报告)

目的:探讨脾部分切除术治疗脾良性肿瘤的疗效.方法:对16例脾良性肿瘤施行脾部分切除手术.其中6例采用脾部分切除加大网膜包裹残面术,10例采用脾部分切除加止血凝胶覆盖.对术后并发症进行统计.结果:16例中1例术后出现左膈下脓肿,1例脾部分坏死,余无并发症发生.平均住院时间12d.结论:脾部分切除术治疗脾良性肿瘤术后并发症少,住院时间短,是安全有效的手术.     

Partial resection of the spleen in the treatment of benign and traumatic lesions

It has been thought that the spleen is an organ without important functions, until recently. That is, why splenectomy has been the procedure of choice in a treatment of splenic diseases. Even now, when we know the functional [figure: see text] importance of the spleen, splenectomy is performed frequently, regardless of its complications. The need of spleen functions salvage, favours partial resection of the spleen as competitive in a treatment of its traumatic and benign lesions. Improvement in diagnostic procedures, surgical techniques, transfusiology and postoperative treatment, will promote it as a treatment of choice. The authors of this study have experience with 17 partial resections of the spleen for traumatic, 11 for benign lesions of the spleen, and one ectopic spleen with hypersplenism, without mortality and with insignificant complications.     

Laparoscopic management of benign cystic lesions of the liver

We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31 patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size of the solitary liver cysts was 14 cm (range, 7–22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control bleeding. The median operative time was 141 min (range, 94–165 min) for patients with PLD and 179 min (range, 88–211 min) for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1–3 days), 3 days (range, 2–7 days), and 5 days (range, 2–17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range, 3–78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999     

Lymphoepithelial cysts and cystic lymphangiomas: Underrecognized benign cystic lesions of the pancreas

AIM: To identify their diagnostic and prognostic clinical characteristics in a large series.METHODS: Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital.RESULTS: Twelve patients were identified between 1/1/1997 and 8/1/2007. Their median age was 55.5 years(range 19-78 years), and 6 were females. The le-sion was incidentally discovered in half of the patients.Contrast enhanced computed tomography demonstrat-ed that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma inva-sion. Endoscopic ultrasound with fine needle aspiration(EUS/FNA) confirmed the diagnosis of a lymphoepithe-lial cyst in 3 patients, one of whom was spared an op-eration and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenecto-mies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm(range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred.CONCLUSION: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomog-raphy scans and EUS/FNA. If the lesion is asymptom-atic, an operation might be avoided.     

Allograft in the treatment of benign cystic lesions of bone

Summary Seventeen patients with benign cystic osseous lesions were treated by curettage and grafting using allogenic decalcified bone. Human bones were partially decalcified using 0.6N HCl and preserved in 90% ethanol in a deep freezer at -16°C. The cystic lesions were: 5 cases of fibrous dysplasia, 4 aneurysmal bone cysts, 3 simple bone cysts, 2 giant-cell tumours, 1 chondromyxoid fibroma, 1 non-ossifying fibroma and 1 fibrous cortical defect. The bones involved were: femur, tibia, humerus, fibula and calcaneum. Infection was a complication in three patients. In two of these it did not interfere with healing, but in one it persisted for more than 1 year with partial resorption of the graft. The time to adequate incorporation of the graft varied from 6 to 9 months in children and 9 to 15 months in adults. The overall response compares favourably with that to allograft from more sophisticated bone banks.     

腹腔镜下脾部分切除术治疗脾脏良性病变7例

目的 探讨腹腔镜下脾部分切除术治疗脾脏良性病变的安全性和可行性。方法 回顾性分析2015年1月至2018年12月期间,金华市中心医院对7例术前诊断为脾脏良性病变的患者实施腹腔镜下脾部分切除术的临床资料。结果 7 例患者脾脏病灶直径为6～15 cm,平均直径9.1 cm;4例位于脾脏上极,3例位于脾脏下极。7例患者均完成腹腔镜脾部分切除术,无中转开腹及围手术期死亡。手术时间为100～205 min,平均（165±17）min。术中出血量为70～230 mL,平均（148±56）mL。术后拔除腹腔引流管时间2～5 d;术后住院时间5～7 d。术后无腹腔大出血、消化瘘、腹腔感染等并发症。结论 腹腔镜下脾部分切除术治疗脾脏良性病变是安全可行的。     

胰腺囊性肿瘤良恶性诊断的影响因素

目的 鉴别胰腺囊性肿瘤良恶性诊断的影响因素.方法 回顾性分析北京协和医院1984年1月至2008年6月126例胰腺囊性肿瘤的病例数据、资料.根据病变组织学特征将病人分为恶性与良性两组,评估各种术前因素对恶性胰腺囊肿诊断的预测价值.结果 126例胰腺囊性肿瘤病人中,37例为恶性,89例为良性.单变量分析显示病人性别、症状(黄疸和体重下降)、血清CA199升高以及肿瘤内存在突起、实性成分或分隔等影像学特征在良恶性病变间存在显著差异.多因素分析显示病人性别和肿瘤的影像学特征是恶性肿瘤的独立预测因素.结论 病人性别,肿瘤大小、临床症状(黄疸或消瘦)、影像学特征(肿瘤内有乳头状突起、实性成分或分隔)和血清CA199是诊断胰腺恶性囊性肿瘤的重要指标,临床可据此确定是否手术治疗.     

Anatomy of splenectomy for ruptured spleen

This article describes the anatomy, blood supply and relationships of the spleen and details the surgical anatomical steps to be taken in an emergency splenectomy for traumatic rupture.     

Laparoscopic splenectomy for epithelial cyst of the spleen

Splenic cysts of all types are a relatively rare entity. The origin of epithelial cysts of the spleen is controversial, most probably congenital in origin. Generally, epithelial cysts of the spleen are asymptomatic and discovered incidentally. We present the case of a 40-year-old woman with a 3.5 cm splenic cyst diagnosed four years before. The cyst raised progressively in dimension, the actual size being of 6.5 cm. Computed tomography scan and magnetic resonance showed a central splenic cyst in close relations with main splenic vessels. An initial indication of partial splenectomy was established, eventually a total splenectomy being performed by laparoscopy due to close relations of the cyst with the main hilar splenic vessels. The hemostasis was assured with the aid of Ligasure Atlas 10 mm instrument. The pathology examination revealed a multilocular splenic cyst with a cuboidal epithelial lining. Central localization of splenic cysts represents an indication for total splenectomy. Laparoscopy provides a minimal access method of obtaining pathological confirmation of diagnosis, reduction of cyst complications, and a short hospital stay. This article discusses different aspects of epithelial cysts related to pathology, diagnostic and indications for operative treatment, a review of the literature being also presented.     

Laparoscopic splenectomy for isolated sarcoidosis of the spleen

Sarcoidosis is a granulomatous disease of unknown etiology. Over 90% of patients with sarcoidosis present with pulmonary findings at the time of diagnosis. Extrapulmonary involvement is common, including the liver, eyes, central nervous system, lymph nodes, and joints. However, isolated granulomatous disease confined to the spleen is rare. This report documents a rare case of isolated granulomatous disease of the spleen diagnosed and treated laparoscopically. A 47-year-old female presented to her internist with nausea and mild epigastric abdominal pain. Laboratory evaluation revealed slightly elevated bilirubin and liver function tests as well as neutropenia. An abdominal ultrasound revealed normal biliary and pancreatic anatomy and multiple splenic lesions. Computed tomography of the abdomen confirmed the multiple hypodense lesions within the spleen. The differential diagnosis at this time included neoplasm, infection, and autoimmune etiologies. Subsequently, the patient underwent a diagnostic laparoscopy with splenectomy. No other intra-abdominal pathology was found. Pathology revealed multiple noncaseating, splenic granulomas. Isolated extrapulmonary manifestations of sarcoidosis occur in only 10% of these patients. Moreover, isolated splenic sarcoidosis is rare. Currently, the literature documents only two prior cases of sarcoidosis presenting with isolated splenic lesions. Primary management consists of medical therapy with prednisone, methotrexate, and/or antimalarial drugs. Indications for surgery include symptomatic splenomegaly, severe hypersplenism, prophylaxis for splenic rupture, and neoplastic exclusion. Our patient required a laparoscopic splenectomy for diagnostic purposes and neoplastic exclusion. Once diagnosed, patients require continual follow-up for systemic manifestations and associated complications of sarcoidosis.     

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 post-operative 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.     

高频超声在睾丸内良性囊性病变中的应用

目的探讨高频超声对睾丸内良性囊性病变的应用价值。方法对1142例患者行睾丸超声检查,对检出的55例睾丸内良性囊性病变的超声图像及临床资料进行分析。结果55例患者中,白膜囊肿5例,睾丸囊肿25例,睾丸网扩张7例,睾丸血肿6例,睾丸脓肿2例,表皮样囊肿5例,良性畸胎瘤5例。术前1例睾丸良性畸胎瘤误诊为恶性。超声诊断本类病变的敏感度为100%,诊断符合率为98.18%。白膜囊肿及睾丸囊肿具有单纯囊肿的一般特征,睾丸网扩张显示为睾丸纵隔部位的条状蜂窝样扩张,睾丸血肿及睾丸脓肿回声混杂,典型的表皮样囊肿具有＂洋葱环＂征,良性畸胎瘤回声混杂。结论高频超声可以对睾丸内良性囊性病变进行正确识别,可视为首选检查方法。     

Allogenic decalbone in the repair of benign cystic lesions of bone

Summary Forty-six cases of benign cystic lesions of bone were treated by curettage and compact filling using partially decalcified allogenic bone graft (Decalbone); of these, 35 were available for study. Decalbone was prepared by partial decalcification with 0.6 N hydrochloric acid (HCl) of human bones generally obtained from freshly amputated limbs. The commonest lesions of bone were giant cell tumours (14) and aneurysmal bone cysts (15), and the commonest bones involved were the femur (23) and the tibia (12). There was one failure and four recurrences. Five cases were infected but this did not interfere with healing of the primary lesion. Radiological incorporation of the graft was seen at about 3 months in unicameral bone cysts, at 4–6 months in aneurysmal bone cysts and at 6–9 months in giant cell tumours. There was no recurrence in any case of giant cell tumour, but three aneurysmal bone cysts recurred. There was no clinical immune reaction.

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Résumé Le «décalbone» est préparé par décalcification partielle (par NHCl) d'os humain, généralement obtenu à partir de pièces d'amputation fraîches. Il est ensuite conservé dans l'éthanol à 80–90° dans un réfrigérateur ordinaire, jusqu'à utilisation. 46 malades, porteurs de lésions kystiques bénignes, 14 tumeurs à cellules géantes (TCG), 15 kystes anévrysmaux, 6 kystes essentiels, 9 dysplasies fibreuses et 2 fibromes ossifiants, ont été traités par curetage et comblement à l'aide de décalbone allogène. Les os les plus fréquemment atteints étaient le fémur (23 fois) et le tibia (12 fois). Il y a en un échec et quatre récidives. Cinq infections sont survenues, qui n'ont pas empêché la guérison de la lésion initiale. L'incorporation radiologique de la greffe a été visible aux environs du 3ème mois dans les kystes essentiels, entre 4 et 6 mois dans les kystes anévrysmaux et entre 6 et 9 mois dans les TCG. Il n'y a eu aucune récidive dans les TCG, mais 3 dans les kystes anévrysmaux. On n'a pas observé de réaction clinique de rejet. Dans l'ensemble les résultats peuvent être favorablement comparés à ceux des allogreffes conservées dans des banques d'os sophistiquées.

     

Laparoscopic management of benign solid and cystic lesions of the liver

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.     

手助腹腔镜脾切除术治疗外伤性脾破裂的临床应用

目的探讨手助腹腔镜脾切除术治疗外伤性脾破裂的可行性及临床意义. 方法 2002年1月～2003年1月,采用手助腹腔镜脾切除术治疗外伤性脾破裂18例,Buntain CT分级Ⅱ型7例,Ⅲ型11例.其中12例合并其它脏器损伤.结果 16例顺利完成手术,手术时间75～115 min,平均92.5 min.2例因术中怀疑有其它大血管破裂而中转开腹手术.术后恢复正常工作时间:6例单纯脾破裂20～30 d,有合并伤10例30～100 d. 结论手助腹腔镜脾切除术治疗外伤性脾破裂切实可行,适用于Buntain CT分级Ⅱ、Ⅲ型脾脏损伤且无严重合并伤的患者.     

Hand-assisted laparoscopic splenectomy for ruptured spleen

Although the laparoscopic technique is an accepted method for elective splenectomy, it is controversial in the setting of trauma. A few reports have described laparoscopic splenorrhaphy for trauma, but none have performed laparoscopic splenectomy for splenic rupture. When the spleen is injured, vascular control and poor visibility due to bleeding present obstacles to laparoscopy. The development of the hand-assist device has helped surgeons make the transition from laparotomy to laparoscopy because of the advantages it provides, such as tactile sensation and immediate vascular control. We utilized these benefits of the hand-assist device to convert a laparoscopic operation to a hand-assisted laparoscopic operation and were thus able to avoid a laparotomy. We report a case in which the hand-assist device was used as an alternative to conversion during a laparoscopic splenectomy for ruptured spleen.     

腹腔镜脾切除治疗外伤性脾破裂

目的探讨采用腹腔镜脾切除的方法治疗外伤性脾破裂的可行性. 方法 2004年8月～2005年5月我院采用腹腔镜脾切除方法治疗外伤性脾破裂8例. 结果 7例顺利完成腹腔镜脾切除术,1例改行手辅助腹腔镜脾切除术成功.手术时间150～200 min,平均180 min.术中出血量600～5 500 ml,平均2 200 ml.Ⅱ级损伤5例,Ⅲ级3例,术后恢复佳,无并发症. 结论腹腔镜脾切除治疗外伤性脾破裂安全、可行.     

腹腔镜巨脾切除术

目的: 探讨腹腔镜脾切除术治疗乙肝后肝硬化门静脉高压脾功能亢进的方法和疗效.方法: 对8例乙肝后肝硬化门静脉高压脾功能亢进患者采用腹腔镜脾切除术.在腹部放置3个套管,脾周韧带及脾门用超声刀解剖,脾门血管用Endo GIA夹闭离断.结果:8例病人均顺利完成腹腔镜脾切除术,无中转开腹,无术后并发症发生.术后血小板明显上升,从平均36×109/L[(17~56)×109/L]升至437×109/L[(316~624)×109/L],随访7~24个月血小板均大于100×109/L.结论: 超声刀、Endo GIA等先进技术的应用已使腹腔镜脾切除术成为治疗乙肝后肝硬化门静脉高压脾亢有效的手术方法.     

Robotic partial splenectomy for hydatid cyst of the spleen

Background  

Primary splenic involvement is an uncommon manifestation of hydatid disease. Partial laparoscopic splenectomy can be performed with lower risks and good hematological results by preserving the immunological function of the spleen. The aim of this study was to outline the advantages of robotic partial splenectomy as a treatment for splenic hydatid cysts.