腹腔镜脾切除178例临床分析

目的总结12年来行腹腔镜脾切除术（laparoscopic splenectomy，LS）的临床经验，探讨肝硬化、门静脉高压症、继发性脾功能亢进和巨脾患者行LS的安全性和有效性。方法回顾性统计分析178例（主要是肝硬化、继发性脾功能亢进和血液病患者）LS的临床结果，比较巨脾组（62例）和非巨脾组（116例）的平均手术时间、术中失血量、术中输血量、中转开腹手术率、并发症发生率和术后住院时间。结果178例LS中转行开腹脾切除术4例（2.2％），出现并发症21例（11．8％）；巨脾组和非巨脾组平均手术时间分别为3．0h和2.4h，并发症发生率分别为21.0％和6.9％，术后住院时间分别为（8.0±2，2d）和（6.6±1.7d），两组的差异均有统计学意义（均P〈0．05）；两组术中失血量、术中输血量和中转开腹手术率的差异均无统计学意义（均P〉0．05）.结论LS安全、有效，适用于有脾切除指征的各种脾疾病，肝硬化、门静脉高压症、继发性脾功能亢进和巨脾不是LS的禁忌证。

Laparoscopic splenectomy: a report of 178 cases

Objective To review the experience of laparoscopic splenectomy （LS） performed in our hospital. Methods One hundred and seventy-eight LS were performed during Apr 1996 to Mar 2008, mainly for hypersplenism secondary to cirrhosis and portal hypertension and long-term hematologic diseases, among which 62 cases had massive splenomegaly（a long axis exceeding 20 cm）and 116 had normal or moderately enlarged spleen. Perioperative data of LS for massive splenomegaly were compared with those of non-massive splenomegaly, including average operative time, intraoperative blood loss, blood transfusion, conversion rate, complication rate and postoperative stays. Results LS was completed in 174 patients, 4 cases converted to open surgery （2.2%） because of hemorrhage, and 21 patients had complications （ 11.8% ）. There were significant differences between massive and non-massive splenomegaly on average operation time （ 3.0 vs 2.4 h ）, complication rate（21.0% vs 6.9% ）and postoperative stay （8.0 vs 6.6 d ）. However, there were no significant differences between 2 groups in intraoperative blood loss, blood transfusion and conversion rates. Conclusion LS is an effective and safe surgical procedure; hypersplenism secondary to cirrhosis and portal hypertension and massive splenomegaly should not be considered as contraindications for LS.