目的:探讨改良脾脏后外侧入路在腹腔镜巨脾切除术中的临床应用价值。方法:回顾性分析2016年1月至2019年7月在江南大学附属医院接受腹腔镜脾切除术(LS)的巨脾患者临床资料。共入组48例患者，其中男性29例，女性19例，平均年龄55.8岁。根据手术分离脾脏入路分为研究组(n n＝26)：采用改良脾脏后外侧入路，脾蒂最后处理；对照组(n n＝22)：经前入路，建立脾蒂后隧道，脾蒂优先处理。比较两组患者脾切除手术时间、术后胃肠功能恢复时间、术中出血量、中转开腹等指标和术后腹腔感染等并发症。随访预后。n 结果:两组患者脾切除手术时间、术后胃肠功能恢复时间、住院时间等比较，差异均无统计学意义(均n P>0.05)。研究组术中出血量(50.2±15.1)ml、中转开腹2例(7.7%)、术中输血1例(3.8%)，优于对照组的(160.1±40.3)ml、7例(31.8%)、5例(22.7%)，差异均有统计学意义(均n P<0.05)。研究组9例(34.6%)术后发生并发症，优于对照组的13例(59.1%)，差异有统计学意义(n P0.05). The intraoperative blood loss, numbers of patients with convention to open surgery and intraoperative blood transfusion, were (50.2±15.1) ml vs (160.1±40.3) ml, 2 patients (7.7%) vs 7 patients (31.8%), and 1 patients (3.8%) vs 5 patients (22.7%), in study group and control group respectively. The differences between groups were significant (alln P<0.05). The complications of the study group and control group were 9 patients (34.6%) vs 13 patients (59.1%), which were significantly in the two groups (n P<0.05). On follow-up which ranged from 1 to 15 months, the numbers of patients with thrombocytosis and portal vein thrombosis in the study group and the control group were 20 patients (76.9%) vs 17 patients (77.3%), and 7 patients (26.9%) vs 6 patients (27.3%), respectively.n Conclusion:The modified posterolateral laparoscopic approach for resection of massive splenomegaly was safe and feasible. It should be promoted to treat massive splenomegaly.