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首页> 外文期刊>Surgical Endoscopy >Single incision approach for splenic diseases: a preliminary report on a series of 8 cases.
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Single incision approach for splenic diseases: a preliminary report on a series of 8 cases.

机译：脾脏疾病的单切口法：一系列8例的初步报告。

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BACKGROUND: There is a current trend to reduce the invasiveness of minimally invasive procedures, and the single-incision laparoscopic approach (SILS) has been proposed for several intra-abdominal surgical interventions. The spleen poses specific problems for techniques, such as SILS, due to its volume and texture, and little clinical information is available on the topic. We describe our initial experience using SILS for the management of splenic diseases. METHODS: Between December 2008 and September 2009, we attempted SILS in eight patients: four men and four women with a median age of 44 (range, 26-73) years, and body mass index of 24.5 (range, 18-31). Preoperative diagnosis was malignancy (n = 3), ITP (n = 1), HIV-related hypersplenism (n = 1), spherocytosis (n = 1), and splenic cyst (n = 2). SILS was attempted transumbilically in four cases and through a 15-mm subcostal single incision in the other four. As entry port we used either three trocars (one of 12 mm and two of 5 mm) inserted through the single-site incision or the umbilicus, or a multiport (Triport, Olympus) device. Instrumentation used consisted of curved instruments, a flexible-tip 10-mm scope, and the harmonic scalpel. Visualization of the spleen and standard dissection of attachments was accomplished, and splenectomy was completed by stapling of the splenic hilum. The spleen was extracted through the single-site incision. In two cases, unroofing of a splenic cyst was performed transumbilically. RESULTS: The SILS procedure was successful in six of the eight patients (75%). Conversion to conventional laparoscopic splenectomy (LS) was required in two patients due to adhesions and spleen size. Median operative time was 97 (range, 60-150) min. There were no postoperative complications, and median stay was 4 (range, 2-5) days. Median spleen weight was 485 (range, 340-590) g. CONCLUSIONS: SILS access can be safely used for operative visualization, hilum transection, and spleen removal, further reducing parietal wall trauma. The definitive clinical, esthetic, and functional advantages require further analysis.
机译：背景：目前有一种减少微创手术的侵入性的趋势，并且已针对几种腹腔内外科手术提出了单切口腹腔镜手术方法（SILS）。脾脏由于其体积和质地而对诸如SILS之类的技术提出了特定的问题，关于该主题的临床信息很少。我们描述了使用SILS治疗脾脏疾病的最初经验。方法：2008年12月至2009年9月，我们对8例患者进行了SILS尝试：四名男性和四名女性，中位年龄为44岁（26-73岁），体重指数为24.5岁（18-31岁）。术前诊断为恶性（n = 3），ITP（n = 1），HIV相关性脾功能亢进（n = 1），球囊增多症（n = 1）和脾囊肿（n = 2）。曾有4例通过脐带尝试了SILS，其他4例尝试了15mm肋下单切口。作为进入口，我们使用了通过单部位切口或脐带插入的三个套管针（12 mm的一个和5 mm的两个）或多端口（Triport，Olympus）装置。所使用的仪器包括弯曲的仪器，10 mm的柔性尖端示波器和谐波解剖刀。脾脏的可视化和附件的标准解剖完成，并通过脾门的吻合术完成脾切除术。通过单部位切口提取脾脏。在两种情况下，通过脐带对脾囊肿进行房顶。结果：8名患者中有6名（75％）成功完成了SILS手术。由于粘连和脾脏大小，两名患者需要转换为常规腹腔镜脾切除术（LS）。中位手术时间为97（范围60-150）分钟。没有术后并发症，中位住院时间为4（范围2-5）天。脾中位数为485（范围340-590）g。结论：SILS通路可安全用于手术可视化，肺门横切和脾切除，从而进一步减少顶壁壁创伤。明确的临床，美学和功能优势需要进一步分析。

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