Liu D C, Meyers M O, Hill C B, Loe W A
Division of Pediatric Surgery, Children's Hospital of New Orleans and Louisiana State University School of Medicine, 70118, USA.
Am Surg. 2000 Dec;66(12):1168-70.
Minimally invasive surgery has recently gained acceptance as the surgical approach of choice for a variety of surgical disorders in children. Although traditional open surgery is still regarded as the standard approach for a splenectomy in children when necessary for hematologic disorders a few cases of successful laparoscopic splenectomy (LS) have been reported. We present our initial 11 cases of LS in children assessing surgical outcome. Eleven patients ages 2 through 15 years underwent LS between June of 1996 and July of 1999 at the Children's Hospital of New Orleans. Indications for surgery included idiopathic thrombocytopenic purpura, congenital spherocytosis, and hemolytic anemia. In all patients the diameter of the spleen was less than 15 cm. Surgical outcome was assessed according to the following parameters: operative time, postoperative length of stay, postoperative morbidity, and cosmetic results. Data were accumulated on the basis of retrospective chart review. LS was completed in all 11 patients. Postoperative morbidity was minimal and the median postoperative stay was 2.4 days (range 1-5). Mean operative time was 3 hours and 10 minutes (range 1.5-7 hours) with the last six procedures completed in an average of just over 2 hours. Intravenous analgesia was discontinued in <48 hours in all patients. Cosmetic results were judged excellent in all cases. We conclude that LS was safe in children with certain hematologic disorders. Adequate selection of patients, appropriate preoperative preparation of patients, meticulous surgical technique, and careful postoperative care were key factors in obtaining the same long-term results as with open surgery.
近年来，微创手术已成为治疗儿童多种外科疾病的首选手术方法。尽管传统开放手术在治疗血液系统疾病必要时进行儿童脾切除术仍被视为标准方法，但已有少数成功的腹腔镜脾切除术（LS）病例报道。我们介绍了我们最初的11例儿童LS病例，并评估了手术结果。1996年6月至1999年7月期间，11例年龄在2至15岁的患者在新奥尔良儿童医院接受了LS手术。手术指征包括特发性血小板减少性紫癜、先天性球形红细胞增多症和溶血性贫血。所有患者脾脏直径均小于15厘米。根据以下参数评估手术结果：手术时间、术后住院时间、术后发病率和美容效果。数据是通过回顾性病历审查收集的。所有11例患者均完成了LS手术。术后发病率极低，术后中位住院时间为2.4天（范围1 - 5天）。平均手术时间为3小时10分钟（范围1.5 - 7小时），最后6例手术平均用时略超过2小时。所有患者均在<48小时内停用静脉镇痛。所有病例的美容效果均被判定为极佳。我们得出结论，LS对于患有某些血液系统疾病的儿童是安全的。充分选择患者、对患者进行适当的术前准备、细致的手术技术以及精心的术后护理是获得与开放手术相同长期效果的关键因素。
