Bada-Bosch Isabel, Mata David Peláez, de la Torre Manuel, Ordóñez Javier, Blanco María Dolores, de Agustin Juan
Department of Pediatric Surgery, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
European J Pediatr Surg Rep. 2020 Jan;8(1):e81-e85. doi: 10.1055/s-0040-1716894. Epub 2020 Oct 21.
Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence. Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.
部分脾切除术可保留良性脾脏病变（如表皮样囊肿）的免疫功能。确定脾切除平面及脾残余的灌注情况可能较为困难，尤其是对于位于脾脏中央的病变。我们报告一例13岁女孩，其脾脏门旁有一个直径6厘米的有症状脾囊肿。通过10毫米脐部入路及三个辅助5毫米端口进行了腹腔镜部分脾切除术。术中以0.2毫克/千克的剂量静脉注射吲哚菁绿（ICG），指导仔细解剖脾门，并在上部动脉分支夹闭后检查脾脏灌注情况。随后ICG的洗脱使得能够通过脾极静脉检查脾残余的外周血管回流情况。手术过程顺利，失血极少。随访超声扫描显示脾残余灌注良好，无复发迹象。腹腔镜部分脾切除术对于良性脾脏肿瘤是可行的，尤其是对于那些位于外周的病例。在解剖学和技术上复杂的部分脾切除术病例中，荧光有助于安全解剖脾门、可视化脾脏横断平面以及脾残余的灌注情况。
