切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (06) : 783 -788. doi: 10.3877/cma.j.issn.2095-3232.2024997

专家论坛

腹腔镜巨脾切除术:逐步打破的手术壁垒
卓文锋1, 曾桂芳1, 杨思加2, 赵家立1, 邹宝嘉1, 白子锐1, 林恩1, 李坚1,()   
  1. 1.519000 珠海,中山大学附属第五医院肝胆外科
    2.510120 广州,中山大学孙逸仙纪念医院肝胆外科
  • 收稿日期:2024-06-23 出版日期:2024-12-10
  • 通信作者: 李坚

Laparoscopic megasplenectomy: gradually overcoming surgical barriers

Wenfeng Zhuo1, Guifang Zeng1, Sijia Yang2, Jiali Zhao1, Baojia Zou1, Zirui Bai1, En Lin1, Jian Li1,()   

  1. 1.Department of Hepatobiliary Surgery,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China
    2.Department of Hepatobiliary Surgery,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China
  • Received:2024-06-23 Published:2024-12-10
  • Corresponding author: Jian Li
引用本文:

卓文锋, 曾桂芳, 杨思加, 赵家立, 邹宝嘉, 白子锐, 林恩, 李坚. 腹腔镜巨脾切除术:逐步打破的手术壁垒[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 783-788.

Wenfeng Zhuo, Guifang Zeng, Sijia Yang, Jiali Zhao, Baojia Zou, Zirui Bai, En Lin, Jian Li. Laparoscopic megasplenectomy: gradually overcoming surgical barriers[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 783-788.

腹腔镜巨脾切除术(LSMS)曾一度被列为微创手术禁忌。然而,近年来随着微创理念和技术设备的不断发展,LSMS逐渐开展,并呈现出技术扁平化的时代特点,得到越来越广泛的应用,渐有成为首选术式的趋势。现笔者结合相应文献资料及个人体会,就LSMS的发展及手术特点作一总结,并对其技术难点与对策及未来进展进行探讨和展望。

Laparoscopic megasplenectomy (LSMS) has been previously considered as a contraindication for minimally invasive surgery. However,with persistent development of minimally invasive concept and technical equipment,LSMS has been gradually carried out in recent years,showcasing the characteristics of the era of flattening technology,which has been widely applied and has gradually become the optimal surgery. Based on relevant literature review and clinical experience,the development and surgical characteristics of LSMS were summarized,and the technical difficulties,countermeasures and future progress were also discussed and predicted in this article.

[1]
Rodríguez-Luna MR,Balagué C,Fernández-Ananín S,et al.Outcomes of laparoscopic splenectomy for treatment of splenomegaly: a systematic review and meta-analysis[J]. World J Surg,2021,45(2):465-479.
[2]
Habermalz B,Sauerland S,Decker G,et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)[J]. Surg Endosc,2008,22(4):821-848.
[3]
Casaccia M,Sormani MP,Palombo D,et al. Laparoscopic splenectomy versus open splenectomy in massive and giant spleens:should we update the 2008 EAES guidelines?[J]. Surg Laparosc Endosc Percutan Tech,2019,29(3):178-181.
[4]
Somasundaram SK,Massey L,Gooch D,et al. Laparoscopic splenectomy is emerging 'gold standard' treatment even for massive spleens[J]. Ann R Coll Surg Engl,2015,97(5):345-348.
[5]
Bemelman WA,de Wit LT,Busch ORC,et al. Hand-assisted laparoscopic splenectomy[J]. Surg Endosc,2000,14(11):997-998.
[6]
Grahn SW,Alvarez J 3rd,Kirkwood K. Trends in laparoscopic splenectomy for massive splenomegaly[J]. Arch Surg,2006,141(8):755-761.
[7]
Casaccia M,Torelli P,Cavaliere D,et al. Minimal-access splenectomy: a viable alternative to laparoscopic splenectomy in massive splenomegaly[J]. JSLS,2005,9(4):411-414.
[8]
Koshenkov VP,Németh ZH,Carter MS. Laparoscopic splenectomy:outcome and efficacy for massive and supramassive spleens[J]. Am J Surg,2012,203(4):517-522.
[9]
刘昆鹏,麻勇,姜洪池. 脾肿大等级判断建议与手术方式选择[J].中国实用外科杂志,2019,39(3):200-202.
[10]
Delaitre B,Maignien B. Splenectomy by the laparoscopic approach.report of a case[J]. Presse Med,1991,20(44):2263.
[11]
Targarona EM,Espert JJ,Balagué C,et al. Splenomegaly should not be considered a contraindication for laparoscopic splenectomy[J].Ann Surg,1998,228(1):35-39.
[12]
Targarona EM,Espert JJ,Cerdán G,et al. Effect of spleen size on splenectomy outcome. a comparison of open and laparoscopic surgery[J]. Surg Endosc,1999,13(6):559-562.
[13]
Owera A,Hamade AM,Bani Hani OI,et al. Laparoscopic versus open splenectomy for massive splenomegaly: a comparative study[J].J Laparoendosc Adv Surg Tech A,2006,16(3):241-246.
[14]
Shin RD,LISR,Levergood NR,et al. Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear[J]. Surg Endosc,2019,33(4):1298-1303.
[15]
Santarelli M,Secco GL,Celi D,et al. Are there any limits for laparoscopy in splenomegaly? our experience[J]. Updates Surg,2021,73(5):1937-1944.
[16]
Patel AG,Parker JE,Wallwork B,et al. Massive splenomegaly is associated with significant morbidity after laparoscopic splenectomy[J]. Ann Surg,2003,238(2):235-240.
[17]
姜洪池,周孟华. 脾脏外科临床研究进展与展望[J]. 中国实用外科杂志,2020,40(1):53-57,61.
[18]
Cheng Z,Li JW,Chen J,et al. Laparoscopic versus open splenectomy and esophagogastric devascularization for bleeding varices or severe hypersplenism: a comparative study[J]. J Gastrointest Surg,2013,17(4):654-659.
[19]
Zheng X,Liu Q,Yao Y. Total laparoscopic versus open splenectomy and esophagogastric devascularization in the management of portal hypertension: a comparative study[J]. Dig Surg,2009,26(6):499-505.
[20]
Vecchio R,Marchese S,Swehli E,et al. Splenic hilum management during laparoscopic splenectomy[J]. J Laparoendosc Adv Surg Tech A,2011,21(8):717-720.
[21]
Ohta M,Nishizaki T,Matsumoto T,et al. Analysis of risk factors for massive intraoperative bleeding during laparoscopic splenectomy[J].J Hepatobiliary Pancreat Surg,2005,12(6):433-437.
[22]
Poulin E,Thibault C,Mamazza J,et al. Laparoscopic splenectomy:clinical experience and the role of preoperative splenic artery embolization[J]. Surg Laparosc Endosc,1993,3(6):445-450.
[23]
Poulin EC,Mamazza J,Schlachta CM. Splenic artery embolization before laparoscopic splenectomy. an update[J]. Surg Endosc,1998,12(6):870-875.
[24]
Iwase K,Higaki J,Yoon HE,et al. Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy[J]. Surg Laparosc Endosc Percutan Tech,2002,12(5):331-336.
[25]
Cai Y,Liu Z,Liu X. Laparoscopic versus open splenectomy for portal hypertension: a systematic review of comparative studies[J].Surg Innov,2014,21(4):442-447.
[26]
Poulin EC,Thibault C,Mamazza J. Laparoscopic splenectomy[J].Surg Endosc,1995,9(2):172-176.
[27]
彭淑牖,彭承宏,陈力,等. 避免损伤胰尾的巨脾切除术——二级脾蒂离断法[J]. 中国实用外科杂志,1999(12):54-55.
[28]
Yan Q,Zhu J,Zhan X,et al. Primary versus secondary splenic pedicle dissection in laparoscopic splenectomy for splenic diseases[J]. J Am Coll Surg,2013,216(2):266-271.
[29]
王玲,李亚晓,邵倩倩. 腹腔镜前入路二级脾蒂离断术在门脉高压患者巨脾切除术中的应用[J]. 腹腔镜外科杂志,2022,27(8):595-597.
[30]
唐勇,李民,曹国军,等. 胰尾后隧道在困难腹腔镜脾切除术中的应用[J]. 腹部外科,2019,32(2):80-83.
[31]
Piardi T,Lhuaire M,Memeo R,et al. Laparoscopic pringle maneuver:how we do it?[J]. Hepatobiliary Surg Nutr,2016,5(4):345-349.
[32]
Tao HS,Lin JY,Luo W,et al. Application of real-time augmented reality laparoscopic navigation in splenectomy for massive splenomegaly[J]. World J Surg,2021,45(7):2108-2115.
[1] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[2] 朱洪宇, 曹越, 赵鑫洋, 周毅. 三孔全腔镜手术治疗中重度男性乳房发育症[J]. 中华乳腺病杂志(电子版), 2024, 18(03): 152-157.
[3] 刘佳瑞, 张宇喆, 宁杨. 经前庭沟切口的骨膜下隧道技术在牙龈退缩治疗中的应用[J]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 143-149.
[4] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国活体肝移植供者微创手术技术指南(2024版)[J]. 中华普通外科学文献(电子版), 2024, 18(04): 241-252.
[5] 向辉, 贾晓斌, 全卫涛. 真空辅助乳腺微创旋切术治疗乳腺纤维瘤的效果及并发症观察[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 528-530.
[6] 唐浩, 梁平, 程千里, 徐小江, 曾凯, 文拨辉. 基于数字化微创技术对复杂性肝胆管结石患者胆道、肝静脉、门静脉解剖与变异情况及应用效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(03): 291-294.
[7] 吕玥彤, 靳梦圆, 周大为, 叶啟发. 机器人辅助下肾移植的临床进展与争议[J]. 中华移植杂志(电子版), 2024, 18(04): 242-246.
[8] 王双兴, 吴永杰, 孟兵, 张宏涛, 刁美, 张辉. 微创切口联合腹腔镜同期治疗先天性心脏病合并心外畸形[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 244-249.
[9] 潘立超, 王兆海, 刘荣. 日间肝切除术2例报道[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 253-256.
[10] 谭佳鸿, 施茹, 赵晗, 张粉, 吴小蝶, 赵琳, 冯云. 经阴道自然腔道内镜手术在妇科良性疾病治疗中的应用[J]. 中华腔镜外科杂志(电子版), 2024, 17(03): 153-159.
[11] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-.
[12] 张宗明, 董家鸿, 何小东, 王秋生, 徐智, 刘立民, 张翀. 老年胆道外科热点问题的争议与思考[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 754-762.
[13] 李澄清, 郭文毅, 王磊. 腹腔镜保留脾脏胰体尾切除术:微创胰腺外科的合理决策[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 620-624.
[14] 彭子洋, 王志博, 王丹, 彭浩茜, 王蕾, 彭薇, 王娟娟, 李宇, 刘学民, 吴荣谦, 向俊西, 吕毅. 智能化辅助图像实时去雾技术在腹腔镜胆囊切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 328-333.
[15] 代剑华, 覃语思, 陈磊, 彭志红, 陈瑶, 刘俐, 吴宏博, 许森林, 李川, 钱锋, 彭贵勇. 术前评估超内镜治疗适应证胃癌的超级微创新选择:内镜、腔镜序贯治疗[J]. 中华胃肠内镜电子杂志, 2024, 11(04): 217-224.
阅读次数
全文


摘要