目的:鉴于腹腔镜脾切除术和根孔断流术(LSD)的技术难题,比较腹腔镜和开腹手术的数据是有限的。随着这项技术的普及,关于它的安全问题,可行性,必须解决可重复性问题。这篇综述评估了LSD的现状。
方法:我们通过检索PubMed数据库进行了文献综述。检查了所有已发表的5个或更多个腹腔镜脾切除术和根孔分离手术。人口统计,术中,术后数据分析包括端口数量,转化率,手术持续时间,术中估计失血量,术后住院时间,和并发症。
结果:15篇文章符合审查标准。在412例腹腔镜手术中,322例(78.2%)患者采用传统腹腔镜脾切除和根孔断流术(TLSD),79例(19.2%)的改良腹腔镜手术(MLSD),11例(2.7%)进行单切口腹腔镜手术(SLSD)。与传统和单切口腹腔镜手术相比,MLSD手术与较短的手术时间和较少的失血相关.此外,尽管腹腔镜手术后门静脉系统血栓形成的发生率高于开腹脾切除术并断流术(OSD),与开放手术相比,LSD手术肺部感染和胸腔积液较少,切口和整体并发症较少.向开放程序的转化率为5.4%。
结论:对于选定的患者,由专业的腹腔镜外科医生进行LSD是可行且安全的。它比OSD具有围手术期优势,但需要进行随访时间较长和患者样本较大的研究.
OBJECTIVE: Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This
review assesses the current status of LSD.
METHODS: We conducted our literature
review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications.
RESULTS: Fifteen articles met the
review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%.
CONCLUSIONS: LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.