Hassoun Jenine, Ortega Gezzer, Burkhalter Lorrie S, Josephs Shellie, Qureshi Faisal G
Division of Pediatric Surgery, Children's Medical Center, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Surgery, Howard University College of Medicine, Washington, DC.
J Surg Res. 2018 Mar;223:142-148. doi: 10.1016/j.jss.2017.09.036. Epub 2017 Nov 24.
The management of nonparasitic splenic cysts in children is unclear. Options include observation, cystectomy, partial or total splenectomy and percutaneous aspiration with and without sclerotherapy. The aim of this study is to assess the outcomes of these interventions at a children's hospital.
A retrospective review of patients aged <18 y with splenic cysts over 7 y was performed. Demographics, mode of intervention, and outcome data were collected.
Forty-two patients were identified and their initial management was as follows: 32 patients were observed and 10 underwent intervention (four aspiration and sclerotherapy and six resection). Age (y) was higher for intervention patients than observation patients (P = 0.004), as was the cyst size (P < 0.001). Incidental finding was the most common presentation in observation patients (n = 30; 94%) and abdominal pain for intervention groups: aspiration and sclerotherapy (n = 3; 75%) and resection (n = 5; 83%). Two patients failed observation and required aspiration and sclerotherapy due to persistence of symptoms or size increase. Median number of aspiration with and without sclerotherapy interventions was three (range 1-5). All six patients had persistence, with two requiring surgical resection due to symptomatic persistence. Surgical procedures included laparoscopic cystectomy (n = 3), laparoscopic partial (n = 2) or complete splenectomy (n = 1), and/or open splenectomy (n = 2). One laparoscopic cystectomy patient had persistence but the other two had no follow-up imaging. Partial and total splenectomy patients had no recurrence and/or persistence.
Observation is an appropriate management strategy for small asymptomatic splenic cysts. Aspiration with and without sclerotherapy and laparoscopic cystectomy are associated with higher rates of recurrence; thus, partial splenectomy may provide the best balance of recurrence and spleen preservation.
儿童非寄生虫性脾囊肿的治疗方法尚不明确。治疗选择包括观察、囊肿切除术、部分或全脾切除术以及经皮穿刺抽吸术（有无硬化治疗）。本研究的目的是评估一家儿童医院中这些干预措施的治疗效果。
对7年间年龄小于18岁的脾囊肿患者进行回顾性研究。收集患者的人口统计学资料、干预方式及治疗效果数据。
共纳入42例患者，其初始治疗情况如下：32例患者接受观察，10例患者接受干预（4例穿刺抽吸加硬化治疗，6例切除）。干预组患者的年龄（岁）高于观察组患者（P = 0.004），囊肿大小也大于观察组（P < 0.001）。观察组患者最常见的表现为偶然发现（n = 30；94%），干预组（穿刺抽吸加硬化治疗组，n = 3；75%；切除组，n = 5；83%）最常见的表现为腹痛。2例观察患者因症状持续或囊肿增大而观察失败，需要进行穿刺抽吸加硬化治疗。穿刺抽吸术（有无硬化治疗）干预的中位数为3次（范围1 - 5次）。所有6例接受切除的患者均有囊肿持续存在，其中2例因症状持续而需要手术切除。手术方式包括腹腔镜囊肿切除术（n = 3）、腹腔镜部分脾切除术（n = 2）或全脾切除术（n = 1），和/或开放脾切除术（n = 2）。1例腹腔镜囊肿切除患者囊肿持续存在，但另外2例未进行随访影像学检查。部分脾切除术和全脾切除术患者无复发和/或囊肿持续存在。
观察是无症状小脾囊肿的一种合适治疗策略。穿刺抽吸术（有无硬化治疗）和腹腔镜囊肿切除术的复发率较高；因此，部分脾切除术可能在复发率和脾脏保留之间提供最佳平衡。
