腹腔镜部分脾切除治疗脾囊肿2例报告并文献复习

脾囊肿相对比较少见,较大囊肿或有压迫症状需外科治疗。传统治疗手段包括脾囊肿开窗引流术和全脾切除术,脾囊肿开窗引流术相对比较简单易行,但术后易出现囊肿复发、积液感染及出血等风险,全脾切除术无复发风险,但破坏患者免疫功能,术后可能出现爆发感染以及静脉血栓;目前认为最理想的治疗方法是行脾部分切除术,既切除病变的脾组织同时也保留了部分健康脾组织,从而保存了脾脏正常的免疫功能。开腹部分脾切除术临床报道较多,但腹腔镜脾部分切除术少见报道。在这里,我们报道两例腹腔镜脾部分切除治疗脾巨大囊肿,术中通过解剖脾门血管,选择性结扎脾上、中极动静脉,在脾缺血带内侧1 cm用超声刀和Hem-o-lok离断脾实质,术后随访无复发。我们认为腹腔镜脾部分切除治疗脾囊肿是安全可行的,具有创伤小、恢复快等优点,值得临床推广应用。     

Partial splenectomy for benign cystic lesions of the spleen

Cystic lesions of the spleen are uncommon, about 600 cases being reported in the world literature. This report concerns three pediatric patients treated by partial splenectomy for benign cyst. In the world literature most of the cystic lesions of the spleen are treated by splenectomy and more recently by partial splenectomy. The infected lesions are treated by splenectomy or by incision and drainage only. Partial splenectomy has evident advantage over splenectomy. Although in the world literature we have not found a single case of infected splenic benign cyst treated by partial splenectomy, we believe that this procedure also has an advantage over drainage as the infected and necrotic part of the cyst is removed, thereby reducing morbidity and further possible complications.     

Laparoscopic splenectomy for a huge splenic cyst without preoperative drainage: report of a case

Laparoscopic splenectomy currently is a safe procedure and offers better cosmetic results, less pain, and a shorter hospital stay than the traditional open procedure. However, there have been only a few reports of laparoscopic removal of giant splenic cysts. An 18-year-old woman was admitted with abdominal fullness. CT scans and MRI images of the upper abdomen revealed a cystic mass having a diameter of 19 cm. Preoperative diagnosis was a large splenic cyst, and laparoscopic splenectomy with intraoperative cyst drainage (amount of drained fluid: 3,000 mL) was performed. Histologically, almost the entire cyst wall was lined with fibrous tissue, but a small portion was covered with stratified squamous epithelium. The final diagnosis was epidermoid cyst. The postoperative course was uneventful. Laparoscopic splenectomy should be tried first even in patients with a huge cyst, and intraoperative drainage under laparoscopic guidance facilitates laparoscopic splenectomy.     

Hand-assisted laparoscopic splenectomy for a huge splenic cyst: operative technique and case report

We report the case of a huge splenic cyst that was successfully treated by hand-assisted laparoscopic splenectomy. A 17-year-old girl with a chief complaint of left-sided abdominal pain was admitted to our department for investigation of a splenic tumor. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a huge cystic lesion in the spleen measuring approximately 10 cm in diameter. Hand-assisted laparoscopic splenectomy was safely performed to diagnose and treat the splenic tumor. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall. Hand-assisted laparoscopic splenectomy may be a good method of managing a huge splenic cyst that becomes symptomatic and potentially life-threatening through enlargement, rupture, and secondary infection.     

Total splenectomy for a recurrent giant splenic cyst

Primary splenic cysts are a rare finding. Some are large and require surgical removal. The Authors report a case of a recurrent huge splenic cyst in a 41-year-old female patient. A marsupialization was performed at another hospital 6 years before. Ultrasonography and computed tomography imaging revealed a cystic lesion in the spleen measuring approximately 20 cm in diameter. A total open splenectomy was performed. Postoperative course was uneventful. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall, as previously found at the first operation. The epidermoid cysts have an epidermal lining, and prevention of recurrence is dependent on complete resection of the cyst wall preserving, whenever possible, the splenic tissue. Recurrence can be avoided with partial splenectomy in polar localization of the cyst, or complete removal of the cyst by "peeling" it off the splenic parenchyma. Marsupialization of the cyst, either via a laparoscopic or an open approach, is often ineffective.     

Epiermoid cyst in the kidney.

Epidermoid cyst of the kidney is a rare entity. In the case here presented, epidermoid cyst was an incidental finding at urography performed in a 67-year-old man in connexion with splenectomy for polycythaemia. The cyst was interpreted as an old tuberculous focus. Two years later partial nephrectomy was performed because of repeated attacks of renal colic and signs of recurrent pyelonephritis. The diagnosis of epidermoid cyst was not made preoperatively in this case, or in the cases described in the literature.     

Hilar localization of splenic cyst does not always exclude the possibility of resective treatment

Non parasitic cysts of the spleen require surgical treatment because of their progressive growth and in order to prevent the potential severe complications associated with such cysts. Since it is now well known that total splenectomy, especially in young patients, has potential for short- and long-term complications, much emphasis has been placed on splenic salvage, suggesting partial splenectomy as procedure of choice for splenic cysts. However various Authors suggest that many but not all splenic cysts can be treated with partial splenectomy. In particular cystic mass arising from the anterior aspect of the hilum near to vascular peduncle contraindicate partial resection requiring splenectomy. In a case observed TC scan demonstrated a very large epidermoid cyst penetrating hilar parenchyma just above splenic vessels insertion. Preoperative imaging suggested splenectomy as the only possible procedure to remove the cyst. At operation the exposure of the splenic artery extended proximally along the pancreatic tail showed an arterial branch running with satellite vein in the splenopancreatic ligament for inferior segment of the spleen. As we found this branch it was possible to resect cyst preserving a large inferior parenchymal segment normally perfused and functioning at postoperative scintigraphic controls. In conclusion not all hilar cysts must be considered an absolute indication to splenectomy. An accurate and extensive exposure of splenic artery and vein can demonstrate vascular anatomical variations permitting resection also for large cysts located near the splenic hilum.     

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 partial splenectomy using the Harmonic Scalpel. Two case reports

For the extirpation of a benign splenic cyst, partial splenectomy is an appropriate approach, since there is significant long-term morbidity following total splenectomy. We report two cases of laparoscopic partial splenectomy for benign splenic cyst. The use of the harmonic scalpel along with segmental ligation of the splenic pedicle allowed the completion of these interventions with minimal blood loss.     

Familial Epidermoid Cysts of the Spleen: Report of Two Cases

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patient's 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 × 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.     

Splenic epidermoid cyst: laparoscopic partial decapsulation

The splenic cysts are rare among all age groups and there are a few reports in the world literature. The splenic epidermoid cyst is a true congenital one, that can cause signs and symptoms, or suffer complications. For these reasons, some form of treatment is recommended. The management of splenic cysts continues to evolve. The standard treatment was splenectomy, but the knowledge about the immunologic function of the spleen and the existence of postesplenectomy mortal sepsis, have conduced most of pediatric surgeons to adopt techniques that preserves splenic tissue. The treatment by percutaneous drainage with injection of a sclerosing agent has complications and a significant recurrence rate. During the last two decades, preservation procedures such as partial splenectomy or partial cyst excision and omental packing have gained the preference of most pediatric surgeons. The second technique has advantages over the partial splenectomy. The possibility to perform the procedure by a laparoscopic approach add the advantages of this last technique. We present two patients with splenic epidermoid cyst treated by laparoscopic partial cyst decapsulation and review the literature.     

Splenic cysts: a new approach to partial splenectomy

Laparoscopic partial splenectomy of a splenic cyst in a 19-year-old female patient is discussed. We successfully performed a laparoscopic partial splenectomy and achieved meticulous hemostasis using an Endo-GIA stapling device. The patient tolerated the procedure well and was discharged on postoperative day 2. At this writing, she has been followed for 30 months without cyst recurrence. Minimally invasive surgery provides an alternative to conventional surgical procedures, with a short hospital stay and without the added morbidity of laparotomy.     

Laparoscopic partial splenectomy using radiofrequency ablation

INTRODUCTION: Epidermoid cysts are believed to be congenital in origin and often present in the pediatric population. Because of the concerns of compromised immunologic function after total splenectomy and increasing demand for minimally invasive approaches, interest has increased in performing the partial splenectomy in this patient population by laparoscopic techniques. Nonetheless, concerns for adequate hemostasis have limited its widespread adoption. Because radiofrequency ablation for the partial splenectomy has been done in a laparoscopic porcine model with good results, we used this technology with the goal of limiting blood loss and postoperative hemorrhagic complications. CASE REPORT: A 25-year-old female presented with complaints of right shoulder pain. Abdominal ultrasound and a computed tomography (CT) scan revealed a 10-cm cystic lesion of the spleen. Serology was negative for hydatid cyst pathology. The patient underwent an uneventful partial splenectomy by minimally invasive techniques with the aid of a laparoscopic radiofrequency ablative device and the placement of a hemostatic medicated sponge along the line of transection. RESULTS: Estimated blood loss was less than 30 mL. Final pathology was consistent with an epidermoid splenic cyst, and the patient was discharged uneventfully on postoperative day 5. DISCUSSION: Techniques for the treatment of symptomatic splenic cysts range from total splenectomy to cyst fenestration and placement of the omentum in the splenic defect. The use of radiofrequency ablation has been traditionally used for hepatic parenchymal transection but seems equally suited for the partial splenectomy. This technology, and the addition of hemostatic sponges, seems to provide excellent results in minimizing blood loss, intraoperatively and postoperatively, during the laparoscopic partial splenectomy; however, randomized, prospective trials will be necessary to see if they will be superior to traditional techniques.     

Large expanding splenic pseudocyst: A case report and review of literature

Introduction and importanceSplenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma.Case presentationA 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst.Clinical discussionThe splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma.ConclusionThe goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.     

Radiofrequency-assisted partial splenectomy with a new and simple device

BACKGROUND: Although partial splenectomy is preferable to total splenectomy for maintaining an immune response, several techniques by which splenic parenchyma were divided in partial splenectomy have been controversial. METHODS: Partial splenectomy using a new and simple device that irradiates radiofrequency combined with saline irrigation was performed successfully for a 19-year-old man with a large splenic cyst. Splenic parenchyma coagulated along the cutting line by the device was divided using an ultrasonic dissector. RESULTS: The surgical field was virtually bloodless during the parenchymal transection. Blood loss during the surgery was 50 mL without transfusion and the other hemostatic procedures and transection time was 10 minutes. The patient's postoperative course was uneventful and he was discharged home with a perfused spleen on postcontrast computed tomography. CONCLUSIONS: The radiofrequency-assisted technique allows partial splenectomy as a safe and virtually bloodless alternative to total splenectomy for selected patients.     

Laparoscopic cystectomy for splenic hydatid cyst: a case report

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.     

Open and laparoscopic treatment of nonparasitic splenic cysts

BACKGROUND: Nonparasitic splenic cysts are rare. Therefore, there is no 'evidence-based' information regarding their optimal surgical management. In the last years the laparoscopic approach has gained increasing acceptance in splenic surgery. The aim of this study is to present our experience with the laparoscopic management of splenic cysts. METHODS:The medical records of 7 patients with splenic cysts were reviewed retrospectively. RESULTS: One patient had an open partial splenic resection. Five patients, 3 of them with a posttraumatic and 2 with an epidermoid splenic cyst, underwent laparoscopic unroofing of the cyst. In 4 of these cases the postoperative course was uneventful, whereas in 1 case the patient developed a cyst relapse soon postoperatively. Later on this patient successfully underwent an open partial splenic resection. The 7th patient had an explorative laparoscopy. The cyst was located intrasplenically, entirely covered with unaffected splenic parenchyma, and reached the splenic hilus. Therefore, a conversion to open partial splenectomy was performed. CONCLUSION: Open partial splenectomy and laparoscopic cyst wall unroofing are both effective tools in the management of splenic nonparasitic cysts. Surgeons must master both techniques as nowadays spleen-preserving techniques should be attempted in every case of splenic nonparasitic cyst.     

Splenic cyst during pregnancy

INTRODUCTION

Splenic cyst during pregnancy is rare and may result in spontaneous rupture during the third trimester, which increases perinatal morality.

PRESENTATION OF CASE

We present a 27-year-old healthy Caucasian female who presented at 18 weeks gestation with left flank pain, early satiety and weight loss. Imaging studies demonstrated a large complex multiloculated splenic cyst. The patient underwent a successful laparoscopic splenectomy and delivered a healthy child at term without complication.

DISCUSSION

Spontaneous rupture of a splenic cyst during the third trimester incurs a perinatal mortality rate as high as 70%. Surgical management includes open or laparoscopic splenectomy or fenestration and preservation of the spleen.

CONCLUSION

Laparoscopic splenectomy during the second trimester appears to be safe and offers definitive management of a large symptomatic splenic cyst during pregnancy.     

Partial Splenectomy in the Management of Nonparasitic Splenic Cysts

Background  Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. Patients and methods  From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15–42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. Results  Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85–160 min), and mean blood loss was 106 ml (55–200 ml). The mean cyst diameter was 9.1 cm (range: 7–17 cm) and weight was 738 g (range: 230–2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. Conclusions  Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.     

Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: Report of a case

INTRODUCTIONBecause splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy.PRESENTATION OF CASEA 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65 U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive.DISCUSSIONAlthough some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts.CONCLUSIONThe treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.