探讨腹腔镜脾部分切除术（LPS）在治疗脾脏良性占位性病变中的安全性及疗效。

回顾性分析2007年6月至2021年9月在南方医科大学顺德医院行腹腔镜手术治疗的28例脾脏良性占位性病变患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男10例，女18例；平均年龄（40±17）岁。根据手术方式不同将患者分为LPS组（15例）和腹腔镜全脾切除术（LTS）组（13例）。LPS组与LTS组均以单发病灶为主；LPS组肿瘤分布主要位于脾脏上下极，LTS组主要位于脾门处。观察两组患者围手术期情况，以及手术方式、术后时间对外周血常规指标的影响。手术前后血常规指标比较采用重复测量方差分析。

患者均顺利完成手术，无中转开腹。两组手术时间、术中出血量、术中输血比例、术后肛门排气时间、术后引流时间、术后住院时间比较差异均无统计学意义（P>0.05）。LPS组术后3 d及3个月WBC分别为（9.0±2.7）×10⁹/L、（6.0±1.9）×10⁹/L，明显低于LTS组的（14.1±4.5）×10⁹/L、（8.2±1.3）×10⁹/L（t=-3.694，-3.488；P<0.05） ；手术方式（t=-2.775，P<0.05）和术后时间（F=53.182，P<0.05）均为影响WBC的主效应因素，二者存在交互效应（F=5.574，P<0.05）。LPS组术后3个月Plt为（236±92）×10⁹/L，明显低于LTS组的（301±59）×10⁹/L（t=-2.199，P<0.05）；术后时间是影响Plt的主效应因素（F=10.490，P<0.05）。

对于脾脏良性占位性病变患者，LPS是一种安全可行、疗效确切的手术方式。LPS在一定程度上保留了脾脏的正常生理功能，对WBC和Plt恢复正常有一定促进作用，可能降低术后感染及血栓形成风险。

To evaluate the safety and efficacy of laparoscopic partial splenectomy (LPS) in the treatment of benign space-occupying lesions in the spleen.

Clinical data of 28 patients with benign space-occupying lesions in the spleen who underwent LPS in Shunde Hospital of Southern Medical University from June 2007 to September 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 10 patients were male and 18 female, aged (40±17) years on average. All patients were divided into the LPS (n=15) and laparoscopic total splenectomy (LTS) groups (n=13) according to different surgical methods. In both LPS and LTS groups, all patients were mainly diagnosed with single lesion. In the LPS group, the lesions were mainly located in the upper and lower segments of the spleen, and primarily distributed in the hilum of the spleen in the LTS group. Perioperative conditions, and the impacts of surgical methods and postoperative time on the routine peripheral blood indexes were also observed between two groups. Routine peripheral blood indexes before and after surgery were compared by repeated-measures ANOVA.

All patients successfully completed the surgery without conversion to open surgery. No significant differences were noted in the operation time, intraoperative blood loss, proportion of intraoperative blood transfusion, time to first flatus, postoperative drainage time and length of postoperative hospital stay between two groups (P>0.05). In the LPS group, the postoperative 3-d and 3-month WBC was (9.0±2.7)×10⁹/L and (6.0±1.9 )×10⁹/L, significantly lower than (14.1±4.5)×10⁹/L and (8.2±1.3)×10⁹/L in the LTS group (t=-3.694, -3.488; P<0.05). Surgical method (t=-2.775, P<0.05) and postoperative time (F=53.182, P<0.05) were the main factors that affected WBC, and two factors exerted interactive effects (F=5.574, P<0.05). In the LPS group, the Plt was (236±92)×10⁹/L at postoperative 3 months, significantly lower than (301±59)×10⁹/L in the LTS group (t=-2.199, P<0.05). Postoperative time was the main influencing factor for Plt (F=10.490, P<0.05).

LPS is a safe, feasible and effective surgical method for patients with benign space-occupying lesions in the spleen. LPS can preserve normal physiological function of the spleen to certain extent, promote the WBC and Plt to normal level, and may reduce the risk of postoperative infection and thrombosis.