Romano Fabrizio, Caprotti Roberto, Franciosi Claudio, De Fina Sergio, Colombo Giovanni, Sartori Paola, Uggeri Franco
Department of General and Pediatric Surgery (Chirurgia I), San Gerardo Hospital, II University of Milan-Bicocca, Via Donizetti 106, 20052 Monza, Italy.
Pediatr Surg Int. 2003 Dec;19(11):721-4. doi: 10.1007/s00383-003-1037-y. Epub 2003 Nov 26.
Laparoscopic splenectomy (LS) is becoming the gold standard for the treatment of hematological disease in children. Intraoperative bleeding is the main complication and main cause of conversion during LS. We present the use of the LigaSure Vessel Sealing System for achieving a safe vascular control, compared with previous techniques.
LigaSure is an energy-based device which works by applying a precise amount of bipolar energy and pressure to the tissue, thus achieving a permanent seal. We have performed a total of 15 LS in children during 6 years, on 6 males and 9 females with a median age of 11 years (range 5-17). Seven children had hereditary spherocytosis, 4 thrombocytopenic idiopatic purpura (ITP), 3 beta talassemia, and 1 hemolytic anemia. Patients were divided into two groups according to the method of dissection: group 1 ultrasonic coagulation+endostapler (8 pts); group 2 LigaSure (7 pts). We employed a 4 trocars technique with right semilateral position.
The groups were well-matched for age, gender, weight, indication and spleen size. Fourteen LS were completed with one conversion (7%) because of hilar bleeding due to accidental injury with endostapler. Median operative time of the series was 140 min (range 90-205), significantly shorter in the group 2 (130 min versus 155 min, P<0.05), as well as median blood loss (group 1, 180 ml versus group 2, 70 ml, P<0.05). There was no mortality, with one postoperative complication (7%) (pulmonary atelectasis). The median postoperative hospital stay was 4 days (range 2-5) without differences between groups.
Each method of dissection seems to be safe and effective. Otherwise LigaSure results in a reduction of operating time and blood loss.
腹腔镜脾切除术（LS）正成为治疗儿童血液系统疾病的金标准。术中出血是LS的主要并发症及中转开腹的主要原因。我们介绍了与以往技术相比，使用LigaSure血管闭合系统实现安全的血管控制。
LigaSure是一种基于能量的设备，通过向组织施加精确量的双极能量和压力来工作，从而实现永久性闭合。6年间我们共对15例儿童实施了LS，其中男性6例，女性9例，中位年龄11岁（范围5 - 17岁）。7例儿童患有遗传性球形红细胞增多症，4例血小板减少性紫癜（ITP），3例β地中海贫血，1例溶血性贫血。根据解剖方法将患者分为两组：第1组采用超声凝血+腔内吻合器（8例）；第2组采用LigaSure（7例）。我们采用四孔技术，患者取右侧半卧位。
两组在年龄、性别、体重、适应证及脾脏大小方面匹配良好。14例LS手术成功完成，1例（7%）因腔内吻合器意外损伤导致肝门出血而中转开腹。该系列手术的中位手术时间为140分钟（范围90 - 205分钟），第2组明显更短（130分钟对155分钟，P<0.05），中位失血量也是如此（第1组180毫升对第组2 70毫升，P<0.05）。无死亡病例，术后有1例并发症（7%）（肺不张）。术后中位住院时间为4天（范围2 - 5天），两组间无差异。
每种解剖方法似乎都是安全有效的。此外，LigaSure可减少手术时间和失血量。
