Ware R, Filston H C, Schultz W H, Kinney T R
Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710.
Ann Surg. 1988 Jul;208(1):17-22. doi: 10.1097/00000658-198807000-00003.
Twenty-seven children with major sickle hemoglobinopathies underwent elective cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 11-14 g/dl with greater than 65% hemoglobin A. Intraoperative cholangiography revealed common bile duct stones in five patients, although only one case was diagnosed by preoperative ultrasonographic examination. Twenty-four children underwent incidental appendectomy by total intussusception. There were no vaso-occlusive events nor any other perioperative morbidity or mortality. Four months after cholecystectomy, one boy had a small bowel obstruction requiring surgical re-exploration. No patients had transfusion-acquired infection, although one boy had erythrocyte allosensitization to Lewis A antigen. This preoperative transfusion regimen and careful perioperative management permits safe elective cholecystectomy in children with sickle cell disease.
27名患有重度镰状血红蛋白病的儿童因胆结石接受了择期胆囊切除术。所有患儿均采用术前输血方案，使血红蛋白浓度达到11 - 14 g/dl，且血红蛋白A含量超过65%。术中胆管造影显示5例患者存在胆总管结石，尽管术前超声检查仅诊断出1例。24名儿童因完全性肠套叠接受了阑尾切除术。未发生血管闭塞事件，也未出现任何其他围手术期并发症或死亡情况。胆囊切除术后4个月，1名男孩发生小肠梗阻，需要再次手术探查。没有患者发生输血获得性感染，不过有1名男孩对Lewis A抗原出现红细胞同种致敏。这种术前输血方案和精心的围手术期管理使镰状细胞病患儿能够安全地接受择期胆囊切除术。
