Takahashi T, Arima Y, Yokomuro S, Yoshida H, Mamada Y, Taniai N, Kawano Y, Mizuguchi Y, Shimizu T, Akimaru K, Tajiri T
First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Tokyo, 113-8605, Japan.
Surg Endosc. 2005 Oct;19(10):1345-8. doi: 10.1007/s00464-004-2210-7. Epub 2005 May 26.
This study assessed the safety and utility of preoperative splenic artery embolization before laparoscopic splenectomy in children.
Five young girls with a mean age of 13.2 years underwent laparoscopic splenectomies at the authors' institution from August 1998 to April 2003. Three of the patients had idiopathic thrombocytopenic purpura, and two had hereditary spherocytosis. Preoperative splenic artery embolization was performed the day before the surgery in all cases. The laparoscopic splenectomy was performed using traditional laparoscopic procedures and standard laparoscopic instruments with the patient in the right semilateral position.
The mean spleen weight was 252.6 g, and the mean length was 11.6 cm. All the patients reported postembolic pain, but not to a level unmanageable by intravascular narcotics. There were no severe complications in the splenic artery embolization. The laparoscopic splenectomies were completed in a mean of 211 min, with a mean estimated blood loss of 9 ml. None of the operations required conversion to traditional open laparotomy, and none of the patients died or experienced operative complications.
The authors concluded that splenic artery embolization is safe and useful as an adjuvant procedure performed before elective laparoscopic splenectomy in children.
本研究评估了儿童腹腔镜脾切除术术前脾动脉栓塞的安全性和实用性。
1998年8月至2003年4月，5名平均年龄为13.2岁的年轻女孩在作者所在机构接受了腹腔镜脾切除术。其中3例患有特发性血小板减少性紫癜，2例患有遗传性球形红细胞增多症。所有病例均在手术前一天进行脾动脉栓塞。采用传统腹腔镜手术和标准腹腔镜器械，患者取右侧半卧位进行腹腔镜脾切除术。
脾脏平均重量为252.6 g，平均长度为11.6 cm。所有患者均出现栓塞后疼痛，但未达到血管内麻醉无法控制的程度。脾动脉栓塞未出现严重并发症。腹腔镜脾切除术平均用时211分钟，平均估计失血量为9 ml。所有手术均无需转为传统开腹手术，且无患者死亡或出现手术并发症。
作者得出结论，脾动脉栓塞作为儿童择期腹腔镜脾切除术术前的辅助操作是安全且有用的。
