Laparoskopische Splenektomie - Technik und Ergebnisse

 

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Zusammenfassung

Die laparoskopische Splenektomie entwickelte sich zum Standardverfahren bei bestimmten Indikationsgruppen, insbesondere bei hämatologischen Erkrankungen. Patienten und Methode: Im Zeitraum vom Juni 1997 bis Juli 2005 führten wir 32 laparoskopische Splenektomien durch. Es wurde der anteriore Zugang mit wahlweise 3 oder 4 Trokaren gewählt. Ergebnisse: Die folgenden Erkrankungen stellten Indikationen zur Operation dar: idiopathische thrombozytopenische Purpura (n = 18), Non-Hodgkin-Lymphome (n = 7), Milzhämangiom (n = 2 ), Sphärozytose (n = 3), Hypersplenismus (n = 1), verkalkte Milzzyste (n = 1). Die mediane Operationszeit betrug 100 min (40-175 min ). Bei 5 Patienten (15,6 %) musste intraoperativ konvertiert werden. Die häufigste intraoperative und postoperative Komplikation stellte die Blutung dar. 2 Patienten entwickelten eine Thrombose der V. portae. Schlussfolgerung: Die laparoskopische Splenektomie stellt ein alternatives Verfahren zur konventionellen Splenektomie dar. Die Methode ist sicher und mit einer geringen Komplikationsdichte durchführbar. Sie stellt mittlerweile das Standardverfahren zur Entfernung der Milz bei hämatologischen Erkrankungen dar. Wegen der Gefahr der Pfortaderthrombose sollte eine postoperative verlängerte Thromboseprophylaxe durchgeführt werden.

Abstract

Laparoscopic splenectomy is considered as standard approach for specific indications, especially hematologic diseases. Patients and methods: Between June 1997 and July 2005 we performed 32 laparoscopic splenectomies. We chose for anterior approach with alternatively 3 or 4 trocars. Results: Following diseases are indications for laparoscopic operation: idiopathic thrombozytopenic purpura (n = 18), Non-Hodgkin-Lymphoma (n = 7), splenic hemangioma (n = 2), spherocytosis (n = 3), hypersplenism (n = 1), calcified splenic cyst (n = 1). Median operation time amounts 100 min (40-175 min). Intraoperative conversion was necessary in 5 patients (15,6 %). Bleeding appears as most frequent intraoperative and postoperative complication was. In 2 patients thrombosis of vena portae developed. Conclusions: Laparoscopic splenectomy represent alternative procedure to conventional splenectomy. Method is feasible sure with low complication rate and is considered as standard approach in removing the spleen in hematologic diseases. Because of the risk of postoperative thrombosis of the vena portae extended thrombosis prophylaxis should be performed.

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Priv.-Doz. Dr. med. Matthias Pross

Klinik für Allgemein-, Viszeral- und Gefäßchirurgie · Otto-von-Guericke-Universität Magdeburg

Leipziger Str. 44

39120 Magdeburg

Phone: 03 91/6 71 55 00

Fax: 03 91/6 72 14 54

Email: Matthias.Pross@medizin.uni-magdeburg.de