Deng Xiao-Geng, Maharjan Anu, Tang Jing, Qiu Rong-Lin, Wu Yao-Hao, Zhang Jie, Zhou Jia-Jia, Zeng Le-Xiang, Chen Mei-Jin, Xiang Yi-Qin, Deng Jie-Min
Department of Pediatric Surgery, The Memorial Hospital of Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou 510120, The People's Republic of China.
Pediatr Surg Int. 2012 Dec;28(12):1201-9. doi: 10.1007/s00383-012-3215-2. Epub 2012 Nov 27.
With the optimal acceptance of its clinical advantages, laparoscopic splenectomy (LS) emerged as a gold standard procedure as compared with open splenectomy (OS). However, it is still controversial and even counted as contraindication for massive splenomegaly. Here, we aim to summarize the experiences, characteristics and trends of modified LS for massive splenomegaly in children with hematological disorders.
Retrospective series of 57 pediatric patients with massive splenomegaly who underwent splenectomy from March 2007 to December 2011 were designated for this clinical analysis. The main outcome measures were dealt by statistics. For 30 cases of LS, we strictly adhered to the principle of using only three trocars to operate and initial ligation of the splenic artery, followed by retrieving the piecemeal of spleen through an accessory incision of 2-3 cm at 12 mm trocar port site.
Of the 57 pediatric patients, 27 underwent OS and 30 underwent LS, respectively. Despite the operative time being shorter for OS than for LS (P < 0.001), the blood loss was lower in LS than in OS (P < 0.001); the time required for oral intake as well as duration of hospital stay was lower in LS than in OS (P < 0.001). Post-operatively, 7 (25.9 %) complications occurred in OS and 3 (10 %) in LS. The conversion rate of LS to OS was 13.33 % in four cases till 2009.
Despite the conflicting reports regarding the safety of LS for massive splenomegaly, we demonstrated that our modified laparoscopic splenectomy in the treatment of children with massive splenomegaly in hematological diseases seemed to achieve the fundamental goal of less invasion; it was safe and feasible.
随着腹腔镜脾切除术（LS）临床优势的最佳接受度，与开放性脾切除术（OS）相比，它已成为一种金标准术式。然而，对于巨脾症，它仍存在争议，甚至被视为禁忌证。在此，我们旨在总结改良LS治疗血液系统疾病患儿巨脾症的经验、特点及趋势。
对2007年3月至2011年12月期间接受脾切除术的57例巨脾症患儿进行回顾性系列研究，用于该临床分析。主要结局指标采用统计学方法处理。对于30例行LS的病例，我们严格遵循仅使用三个套管针操作及首先结扎脾动脉的原则，随后通过在12毫米套管针穿刺孔处做2 - 3厘米的辅助切口将脾脏逐块取出。
57例患儿中，分别有27例行OS，30例行LS。尽管OS的手术时间比LS短（P < 0.001），但LS的失血量比OS少（P < 0.001）；LS的经口进食时间及住院时间均比OS短（P < 0.001）。术后，OS组发生7例（25.9%）并发症，LS组发生3例（10%）。截至2009年，4例LS转为OS的转化率为13.33%。
尽管关于LS治疗巨脾症安全性的报道存在矛盾，但我们证明，我们改良的腹腔镜脾切除术治疗血液系统疾病患儿巨脾症似乎实现了微创的基本目标；它是安全可行的。
