Patkowski Dariusz, Chrzan Rafał, Wróbel Grazyna, Sokół Agnieszka, Dobaczewski Grzegorz, Apoznański Wojciech, Zaleska-Dorobisz Urszula, Czernik Jerzy
Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland.
J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):230-4. doi: 10.1089/lap.2006.0058.
To assess the safety and effectiveness of laparoscopic splenectomy in children.
Hospital records of 63 patients who underwent laparoscopic splenectomy between 1998 and 2005 were reviewed retrospectively. In 16 patients concomitant cholecystectomy was performed. All procedures were performed by the same surgeon. The indications for splenectomy were hereditary spherocytosis (n = 35), idiopathic thrombocytopenic purpura (n = 22), autoimmune hemolytic anemia (n = 3), and other diseases (n = 3). Details of operative technique were reviewed and their implications on intraoperative complications are analyzed. The postoperative course and long-term results were assessed.
There were 35 girls and 28 boys, whose average age was 11.3 years (range, 3.9-19.5 years). There were 7 conversions, mainly at the beginning of the series. A mild degree of intraoperative bleeding was observed in 23 (36.5%) cases. In two cases (3%) severe bleeding led to conversion. Postoperatively, 1 patient required blood transfusion and 1 patient had signs of mild general infection that was treated conservatively. There was no mortality in this series. The mean operation time was 134 minutes for splenectomy and 174 minutes for splenectomy and cholecystectomy. Operative time did not significantly diminish at the end of the 7-year study period.
Laparoscopic splenectomy in children performed by an experienced team proved to be safe and effective with minimal side effects and should be recommended as a procedure of choice in children who require splenectomy.
评估儿童腹腔镜脾切除术的安全性和有效性。
回顾性分析1998年至2005年间63例行腹腔镜脾切除术患儿的医院记录。16例患儿同时行胆囊切除术。所有手术均由同一外科医生完成。脾切除术的适应证为遗传性球形红细胞增多症（n = 35）、特发性血小板减少性紫癜（n = 22）、自身免疫性溶血性贫血（n = 3）及其他疾病（n = 3）。回顾手术技术细节并分析其对术中并发症的影响。评估术后病程及长期结果。
共35例女孩和28例男孩，平均年龄11.3岁（范围3.9 - 19.5岁）。有7例中转开腹，主要发生在手术系列开始时。23例（36.5%）出现轻度术中出血。2例（3%）因严重出血中转开腹。术后，1例患儿需要输血，1例患儿有轻度全身感染迹象，经保守治疗。本系列无死亡病例。单纯脾切除术平均手术时间为134分钟，脾切除联合胆囊切除术平均手术时间为174分钟。在7年研究期结束时，手术时间无明显缩短。
由经验丰富的团队进行的儿童腹腔镜脾切除术被证明是安全有效的，副作用最小，应推荐作为需要脾切除术患儿的首选术式。
