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首页> 外文期刊>Surgical Endoscopy >Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES).
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Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES).

机译：腹腔镜脾切除术：欧洲内窥镜手术协会（EAES）的临床实践指南。

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BACKGROUND: Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS: An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS: Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION: Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
机译：背景：尽管腹腔镜脾切除术（LS）已成为大多数脾切除术病例的标准方法，但仍有一些领域存在争议。迄今为止，尚未明确定义不能进行腹腔镜脾切除术的适应症。有鉴于此，欧洲内窥镜手术协会（EAES）已制定了LS的临床实践指南。方法：邀请了一个国际专家小组来评估当前文献并提出基于证据的建议。 2007年5月召开了使用名义小组程序的共识发展会议。其建议已于2007年7月5日在希腊雅典举行的年度EAES大会上提出，以供讨论和进一步提供参考。在专家之间进行了进一步的Delphi程序后，最终建议得到了同意。结果：腹腔镜脾切除术适用于大多数良性和恶性血液病，与患者的年龄和体重无关。建议进行术前检查以获取有关脾脏大小和体积以及附属脾组织的信息。对于选择性病例，建议术前接种针对B型脑膜炎球菌，肺炎球菌和流感嗜血杆菌的疫苗。所有患者均应给予围手术期皮下肝素预防性抗凝治疗，高危患者应长期预防性抗凝治疗。方法的选择（仰卧[前]，半外侧或外侧）取决于外科医生的偏好和随之而来的情况。在大块脾肿大的情况下，应考虑采用手辅助技术，以避免转换为开放手术并降低并发症发生率。专家小组仍将门脉高压症和主要合并症视为LS的禁忌症。结论：尽管缺乏1级证据，但对于有经验的手来说LS是一种安全且有利的手术方法，对于几乎所有适应症而言，LS均已取代开放手术。为了支持临床证据，必须就不同问题进行进一步的随机对照试验。

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