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首页> 外文期刊>Surgical Endoscopy >Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases (see comments)
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Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases (see comments)

机译：腹腔镜脾切除术不足以检测辅助脾和脾脏。腹腔镜手术在血液系统疾病中的缺点（见评论）

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BACKGROUND: The ultimate goal of surgery for hematological disorders is the complete removal of both the spleen and accessory spleens in order to avoid recurrence of the disease. Whereas splenectomy by open surgery provides excellent results, the validity of laparoscopic splenectomy in this regard remains unknown. OBJECTIVE: The purpose of this study was to evaluate the detection of accessory spleens during laparoscopic splenectomy for hematologic diseases. METHODS: We therefore evaluated the pre-, intra-, and postoperative detection of accessory spleens in a consecutive series of 18 patients treated by elective laparoscopic splenectomy for hematological diseases by using computed tomography (CT) and denatured red blood cell scintigraphy (DRBCS). RESULTS: Preoperative CT, DRBCS, and laparoscopic exploration detected 25%, 25%, and 75% of accessory spleens, respectively. At time of laparoscopy, 16 accessory spleens were detected in seven of the 18 patients (41%). In two patients (11%), laparoscopic exploration failed to detect accessory spleens, whereas preoperative CT (one case) and DRBCS (one case) did reveal them. Postoperatively, during a mean follow-up of 28 months (median, 24; range, 12-44 months), nine patients (50%) showed persistence of splenic tissue by DRBCS, and three of them had signs of disease recurrence. CONCLUSIONS: This prospective clinical study suggests that elective laparoscopic surgery for hematological diseases does not allow complete detection of accessory spleens. Moreover, after such a laparoscopic approach, residual splenic tissue is detectable in half of the patients during the follow-up.
机译：背景：血液系统疾病手术的最终目标是完全切除脾脏和副脾脏，以免疾病复发。尽管通过开放手术进行脾切除术可提供出色的效果，但在这方面，腹腔镜脾切除术的有效性尚不清楚。目的：本研究的目的是评估腹腔镜脾切除术在血液系统疾病中辅助脾的检测。方法：因此，我们通过计算机断层扫描（CT）和变性红细胞闪烁显像（DRBCS）评估了连续18例行选择性腹腔镜脾切除术治疗血液系统疾病的患者的脾脏的术前，术中和术后检查。结果：术前CT，DRBCS和腹腔镜探查分别检出了25％，25％和75％的副脾。在腹腔镜检查时，在18位患者中的7位（41％）中检测到16个辅助脾。在两名患者（11％）中，腹腔镜探查未能发现副脾，而术前CT（1例）和DRBCS（1例）确实显示了它们。术后平均随访28个月（中位24个月;范围12-44个月），有9例患者（50％）表现出DRBCS持续存在脾组织，其中3例有疾病复发的迹象。结论：这项前瞻性临床研究表明，针对血液系统疾病的选择性腹腔镜手术不能完全检测到副脾。而且，在这种腹腔镜方法之后，在随访期间一半患者中可检测到残留的脾脏组织。

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