改良脾脏后外侧入路在腹腔镜巨脾切除术中的应用评价

目的:探讨改良脾脏后外侧入路在腹腔镜巨脾切除术中的临床应用价值。方法:回顾性分析2016年1月至2019年7月在江南大学附属医院接受腹腔镜脾切除术(LS)的巨脾患者临床资料。共入组48例患者，其中男性29例，女性19例，平均年龄55.8岁。根据手术分离脾脏入路分为研究组( n＝26)：采用改良脾脏后外侧入路...

Modified posterolateral laparoscopic approach for resection of massive splenomegaly

Objective To study the feasibility and efficacy of the modified posterolateral laparoscopic approach for resection of massive splenomegaly.Methods The data of 48 patients who underwent laparoscopic splenectomy for massive splenomegaly at the Affiliated Hospital of Jiangnan University(Wuxi 4th People's Hospital)from January 2016 to July 2019 were retrospectively analyzed.There were 29 males and 19 females,with an average age of 55.8 years.These 48 patients were divided into two groups according to the operative approach,the study group(n=26)using the modified posterolateral approach which treated the splenic pedicle as the last step;and the control group(n=22)which used the posterior tunnel of splenic pedicle established by anterior approach to treat the splenic pedicle first.The operation time,gastrointestinal function,recovery time,intraoperative blood loss,rates of conversion to laparotomy and postoperative complications were compared between two groups.The follow-up data were also analyzed.Results There were no significant differences in operation gastrointestinal function recovery and hospitalization time between the two groups(all P>0.05).The intraoperative blood loss,numbers of patients with convention to open surgery and intraoperative blood transfusion,were(50.2±15.1)ml vs(160.1±40.3)ml,2 patients(7.7%)vs 7 patients(31.8%),and 1 patients(3.8%)vs 5 patients(22.7%),in study group and control group respectively.The differences between groups were significant(all P<0.05).The complications of the study group and control group were 9 patients(34.6%)vs 13 patients(59.1%),which were significantly in the two groups(P<0.05).On follow-up which ranged from 1 to 15 months,the numbers of patients with thrombocytosis and portal vein thrombosis in the study group and the control group were 20 patients(76.9%)vs 17 patients(77.3%),and 7 patients(26.9%)vs 6 patients(27.3%),respectively.Conclusion The modified posterolateral laparoscopic approach for resection of massive splenomegaly was safe and feasible.It should be promoted to treat massive splenomegaly.