Rescorla Frederick J, West Karen W, Engum Scott A, Grosfeld Jay L
Department of Surgery, Section of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Ann Surg. 2007 Oct;246(4):683-7; discussion 687-8. doi: 10.1097/SLA.0b013e318155abb9.
The purpose of this report is to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in children.
Review of a prospective database at a single institution (1995-2006) identified 231 children (129 boys; 102 girls; average age 7.69 years) undergoing laparoscopic splenic procedures.
Two hundred twenty-three children underwent laparoscopic splenectomy (211 total; 12 partial) by the lateral approach. Indication for splenectomy was hereditary spherocytosis (111), immune thrombocytopenic purpura (36), sickle cell disease (SCD) (51), and other (25). Four (2%) required conversion to an open procedure. Eight additional laparoscopic splenic procedures were performed: splenic cystectomy for epithelial (4) or traumatic (2) cyst, and splenopexy for wandering spleen (2). Average length of stay was 1.5 days. Complications (11% overall, 22% in SCD patients) included ileus (5), bleeding (4), acute chest syndrome (5), pneumonia (2), portal vein thrombosis (1), priapism (1), hemolytic uremic syndrome (1), diaphragm perforation (2), colonic injury (1), missed accessory spleen (1), trocar site hernia (1), subsequent total splenectomy after an initial partial (1), and recurrent cyst (1). Subsequent operations were open in 3 (colon repair, hernia, and missed accessory spleen) and laparoscopic in 2 (completion splenectomy, and cyst excision). There were no deaths, wound infections, or instances of pancreatitis.
Laparoscopic splenic procedures are safe and effective in children and are associated with low morbidity, higher complication rate in SCD, low conversion rate, zero mortality, and short length of stay. Laparoscopic splenectomy has become the procedure of choice for most children requiring a splenic procedure.
本报告旨在评估儿童腹腔镜脾脏手术的疗效及术后观察到的并发症。
回顾一家机构（1995 - 2006年）的前瞻性数据库，确定231例接受腹腔镜脾脏手术的儿童（129例男孩；102例女孩；平均年龄7.69岁）。
223例儿童通过外侧入路接受了腹腔镜脾切除术（211例全脾切除；12例部分脾切除）。脾切除的指征为遗传性球形红细胞增多症（111例）、免疫性血小板减少性紫癜（36例）、镰状细胞病（SCD）（51例）及其他（25例）。4例（2%）需要转为开放手术。另外还进行了8例腹腔镜脾脏手术：上皮性囊肿（4例）或外伤性囊肿（2例）的脾囊肿切除术，游走脾（2例）的脾固定术。平均住院时间为1.5天。并发症（总体发生率11%，SCD患者中为22%）包括肠梗阻（5例）、出血（4例）、急性胸综合征（5例）、肺炎（2例）、门静脉血栓形成（1例）、阴茎异常勃起（1例）、溶血尿毒综合征（1例）、膈肌穿孔（2例）、结肠损伤（1例）、遗漏副脾（1例）、套管针部位疝（1例）、初次部分脾切除术后再次全脾切除（1例）及囊肿复发（1例）。后续手术中，3例为开放手术（结肠修复、疝修补和遗漏副脾切除），2例为腹腔镜手术（完成脾切除和囊肿切除）。无死亡、伤口感染或胰腺炎病例。
腹腔镜脾脏手术在儿童中安全有效，并发症发生率低，SCD患者并发症发生率较高，中转率低，死亡率为零，住院时间短。腹腔镜脾切除术已成为大多数需要进行脾脏手术的儿童的首选术式。
