Leeds Teaching Hospitals NHS Trust, Children's Liver & GI Unit, Gledhow Wing, St James's University Hospital, Leeds, UK.
Arch Dis Child. 2010 Aug;95(8):596-9. doi: 10.1136/adc.2009.178228. Epub 2010 Jun 7.
BACKGROUND/AIM: The British Committee for Standards in Haematology currently recommends concomitant splenectomy in children with mild hereditary spherocytosis (HS) undergoing cholecystectomy for symptomatic gallstones. However, splenectomy is associated with a risk of life-threatening infection, particularly in young children. The aim of this study was to audit the outcome of the practice of uncoupling splenectomy and cholecystectomy in such patients.
Children referred with symptomatic gallstones complicating HS between April 1999 and April 2009 were prospectively identified and reviewed retrospectively. During this period, the policy was to undertake concomitant splenectomy only if indicated for haematological reasons and not simply because of planned cholecystectomy.
A total of 16 patients (mean age 10.4, range 3.7 to 16 years, 11 women) with HS and symptomatic gallstones underwent cholecystectomy. Three patients subsequently required a splenectomy for haematological reasons 0.8-2.5 years after cholecystectomy; all three splenectomies were performed laparoscopically. There were no postoperative complications in the 16 patients; postoperative hospital stay was 1-3 days after either cholecystectomy or splenectomy. The 13 children with a retained spleen remain under regular review by a haematologist (median follow-up 4.6, range 0.5 to 10.6 years) and are well and transfusion independent.
The advice to perform a concomitant splenectomy in children with mild HS undergoing cholecystectomy for symptomatic gallstones needs revisiting. In the era of minimal access surgery, the need for splenectomy in such children should be judged on its own merits.
背景/目的：英国血液学标准委员会目前建议，对于因胆囊结石而出现症状的轻度遗传性球形红细胞增多症（HS）儿童，在行胆囊切除术时同时行脾切除术。然而，脾切除术存在危及生命感染的风险，尤其是在幼儿中。本研究旨在评估在这种情况下，将脾切除术与胆囊切除术分开进行的效果。
前瞻性地确定 1999 年 4 月至 2009 年 4 月期间因 HS 合并胆囊结石而就诊的患儿，并进行回顾性研究。在此期间，脾切除术仅在存在血液学原因而非单纯因计划进行胆囊切除术时才进行。
共有 16 例（平均年龄 10.4 岁，范围 3.7-16 岁，11 例女性）HS 合并胆囊结石患儿接受了胆囊切除术。3 例患儿随后因血液学原因在胆囊切除术后 0.8-2.5 年需要行脾切除术；所有 3 例脾切除术均通过腹腔镜完成。16 例患儿术后均无并发症；胆囊切除术后或脾切除术后住院时间为 1-3 天。保留脾脏的 13 例患儿仍定期由血液科医生进行随访（中位随访时间 4.6 年，范围 0.5-10.6 年），且状态良好，无需输血。
对于因胆囊结石而出现症状的轻度 HS 儿童，在行胆囊切除术时同时行脾切除术的建议需要重新评估。在微创外科时代，应根据具体情况判断此类患儿是否需要行脾切除术。
