For cases of spleen abnormalities, early examination, diagnosis and treatment is required to avoid the risk of a life-threatening spleen rupture accident. Laparoscopic spleen surgery is the method in which it is inlet for cases of spleen disease, thromboembolysis, hemolysis anemia,…
1. The basic role of the spleen
The spleen is a large mass of blood vessels and lymphous tissue. This body is located in the left quarter of the abdomen, in the cavity created by the diaphragm, stomach, left kidney and left atrial gland, the diaphragm ligament and the chest wall. In adults, the normal spleen has an average weight of 150g, with a limit of 80-300g. The size of the spleen is usually 9 – 11cm long, 7cm wide and 4cm thick.
The biological function of the spleen includes:
- Immune function: Spleen secretes many antibodies against antigens that enter the bloodstream;
- Blood cell creation: During the embryonic period, the spleen is involved in the creation of red blood cells, granular leukocytes. Then, when the child is born, the spleen produces lymphocytes;
- Destruction of blood cells: The spleen is responsible for controlling the quality of blood cells when passing through the spleen. The spleen will destroy old, abnormal or subcytes that no longer function;
- Blood storage: The spleen reserves about 1⁄3 of the number of tinglets and 30ml of red blood cells for the body, which can replenish blood in case of emergency.
2. Spleen laparoscopic surgery in design
2.1 Hemorrhagic autotensive thrombolysis
The characteristics of the disease are reduced tinglets, spleen cuts in which severe illness, non-response or poor response to medical treatment, the number of tinglets is less than 20,000 / mm3. Treatment of spleen removal helps to cure the disease completely or long-term at a rate of 70% in children and 60-80% in adults;
2.2 Thromboembolysis hemorrhage
Is a rare pathology, characterized by symptoms of fever, tingle tingle, hemodialysis anemia, renal failure and neurological disorders. Spleen removal is in place in case of plasma filtration failure or recurrent disease when medical treatment is discontinued.
2.3 Auto-hematoma anemia
This is a consequence of the formation of abnormal antibodies, which causes urethrobial rupture. Usually, spleen removal is in place for medical treatment after 1 year without results and will give a more positive effect in patients under 40 years of age. The response rate after spleen surgery is about 50-80%;
2.4 Hemolysis anemia due to yeast abnormalities in red blood cells
The disease often has symptoms of anemia, enlarged spleen, gallstones. Spleen removal is in addition to not eliminating hemolysemia but helps to increase hemoglobin content, reducing the need for blood transfusions in patients;
2.5 Red blood cell abnormalities
- Small spleen rye: Is the most common pathology in red blood cell membrane abnormalities in which spleen is insevered. Cutting the spleen will reduce the rate of hemolysis, solving anemia. Note, patients with small scyth dyscythala cells are at high risk for gallstones, so abdominal ultrasound should be performed before cutting the spleen. If there is gallstones, it is necessary to cut the gallbladder when cutting the spleen.
- Genetic elliptical red blood cells: Due to abnormalities of the red blood cell membrane and an increase in the destruction of red blood cells. Spleen surgery is insular in the absence of severe hemolysis anemia;
2.6 Primitive spleen
Spleen removal helps relieve the symptoms caused by enlarged spleen, improves blood cell deficiency and eliminates the possibility of latent malignancy;
2.7 Bone marrow failure
Spleen removal is in place for patients with osteomyelitis of unknown causes that prolong the life of red blood cells, increasing the number of tinglets because there is no longer a place to destroy tinglets. At the same time, spleen cutting also helps reduce the amount of antibodies that activate toxic T, release the pulp and restore blood fertility in the pulp;
- Hodgkin's disease: Spleen removal with laparoscopic surgery to identify the disease at an early stage (I and II) when other diagnostic means give unclear results;
- Non-Hodgkin's lymphoma: Symptoms of enlarged spleen (spleen strengthening). Spleen removal can be used as a diagnostic or therapeutic measure when enlarged spleen causes rapid satiety, abdominal pain, discomfort, anemia, tingletemia and polycythemia;
- Hair cell leukemia: Previously spleen cutting played a categoric classification role in the treatment of patients but is now rarely in place;
- Chronic lymphocytic leukemia: Spleen removal helps to prolong the patient's life;
- Chronic myeloid leukemia: Spleen cutting helps reduce disease symptoms, improve blood cell reduction;
Other in addition: Spleen aneurysm, spleen cyst, aneurysm in the spleen artery, blood clots in the blood vessels of the spleen.
3. Contraintical spleen laparoscopic surgery
- Blood clot disorders, heart disease or severe lung disease;
- Excessively large spleen (4th degree);
- Large spleen in cases of osteomyelous growth disorders;
- Increased pressure of the door vein;
- Severe spleen injury.
4. Laparoscopic spleen surgery
Currently, laparoscopic surgery is the standard method for the majority of spleen removal cases. The purpose of the surgery is to remove the entire spleen and spleen (if any), while avoiding tearing the spleen. In cases where an intact spleen needs to be removed for diagnosis, an additional incision may be required.
Advantages of laparoscopic spleen surgery over traditional open surgery:
- Better observation and access to surgery, especially since the spleen is an organ deep in the abdomen;
- Less pain after surgery, faster recovery after surgery;
- After surgery has little effect on respiratory function;
- Less complications related to the incision;
- Small surgical scars, more aesthetic.
Disadvantages of laparoscopic spleen surgery compared to traditional open surgery:
- The duration of surgery is usually longer. Laparoscopic spleen surgery is suitable for medium-sized and medium-sized spleen cases;
- Difficulty controlling bleeding requires a surgeon to have extensive experience;
- The incidence of secondary spleen detection is less than that of open surgery;
- It is necessary to invest in expensive equipment.
5. Complications and treatment after laparoscopic spleen surgery
The incidence of an accident depends on the experience of the surgeon, the size and weight of the armpit, the weight and age of the patient,… Common complications of spleen surgery include:
- Bleeding: Handled by monitoring, blood transfusion or if it is necessary to re-operate to stop the bleeding;
- Spleen pit survival anesthpleen: Active antibiotic treatment is required. If the ansthosive is large, it may require suction under ultrasound;
- Infection of trocar holes: Carry out active antibiotic treatment, while cleaning and changing the incision dressing daily;
- Deep vein thrombosis: The treatment is to strengthen movement and treat fibrosis;
- Pancreatitis: Treatment should be directed towards acute pancreatitis;
- Damage to the next of the muscles: Pancreas, stomach, colon and diaphragm. The handling depends on the injury on the agencies;
- Complications of laparoscopic surgery in general: Appropriate treatment for lesions and complications.
Laparoscopic spleen surgery should be performed promptly as soon as a diagnosis is determined to avoid life-threatening complications. During laparoscopic spleen surgery, the patient should strictly follow the instructions of the doctor.
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- Note after laparoscopic spleen surgery
- Normal and abnormal ultrasound images of the spleen
- Levels of Hemolysis Anemia (Thalassemia)