Indiana University School of Medicine, Indianapolis, IN.
Surgery. 2013 Oct;154(4):849-53; discussion 853-5. doi: 10.1016/j.surg.2013.07.019.
Partial splenectomy is utilized selectively in children with hereditary spherocytosis (HS) to decrease hemolysis while maintaining immunity. Our aim was to compare outcomes between laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS).
After obtaining institutional review board approval, we reviewed the records for all children ≤18 years with HS undergoing LTS and LPS between 2002 and 2012. Wilcoxon rank-sum tests were used.
Eighty-seven HS children underwent LTS (n = 71) and LPS (n = 16). Mean age was 7.1 ± 3.6 years (LTS) and 5.5 ± 2.8 years (LPS; P = .14). Concomitant cholecystectomy was performed in 32% of LTS and 38% of LPS cases. Operative time was 87 ± 33 minutes (LTS) and 140 ± 36 minutes (LPS; P = .0005). Duration of stay was 1.2 ± 0.5 days (LTS) and 2.4 ± 1.4 days (LPS; P = .003). Reticulocyte and hemoglobin levels improved after both operations. LPS children had lower preoperative (8.8 ± 1.9 vs 10.2 ± 1.7 g/dL; P = .0148) and postoperative (10.5 ± 1.7 vs 13.8 ± 1.1 g/dL; P < .0001) hemoglobin levels than did LTS patients. Three LPS children required transfusion (at 2, 4 and 5 postoperative years) for parvovirus-associated aplastic crises. No LTS child developed splenic function or anemia.
These data demonstrate that LPS decreases hemolysis, although LTS is more effective. LPS children had lower preoperative hemoglobin levels, indicating more severe hemolysis. LPS also has greater operative time and duration of stay, disadvantages balanced by retained immunity.
部分脾切除术在遗传性球形红细胞增多症（HS）患儿中被选择性地应用，以减少溶血，同时保持免疫力。我们的目的是比较腹腔镜全脾切除术（LTS）和腹腔镜部分脾切除术（LPS）的结果。
在获得机构审查委员会批准后，我们回顾了 2002 年至 2012 年间所有接受 LTS 和 LPS 的≤18 岁 HS 儿童的记录。使用 Wilcoxon 秩和检验。
87 例 HS 患儿接受了 LTS（n=71）和 LPS（n=16）。平均年龄为 7.1±3.6 岁（LTS）和 5.5±2.8 岁（LPS；P=0.14）。32%的 LTS 和 38%的 LPS 病例同时行胆囊切除术。手术时间为 87±33 分钟（LTS）和 140±36 分钟（LPS；P=0.0005）。住院时间为 1.2±0.5 天（LTS）和 2.4±1.4 天（LPS；P=0.003）。两种手术均可改善网织红细胞和血红蛋白水平。LPS 患儿术前（8.8±1.9 与 10.2±1.7 g/dL；P=0.0148）和术后（10.5±1.7 与 13.8±1.1 g/dL；P<0.0001）血红蛋白水平均低于 LTS 患儿。3 例 LPS 患儿在术后第 2、4 和 5 年因微小病毒相关性再生障碍危象需要输血。无 LTS 患儿发生脾功能或贫血。
这些数据表明，LPS 可降低溶血，但 LTS 更有效。LPS 患儿术前血红蛋白水平较低，表明溶血更严重。LPS 还需要更长的手术时间和住院时间，但其保留了免疫力，这是其优势所在。
