Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China.
Department of Pediatric Surgery, Zhuhai Women and Children's Hospital, Ningxi Road No.543, Region Xiangzhou, Zhuhai, 519000, Guangdong Province, China.
Surg Endosc. 2023 Dec;37(12):9070-9079. doi: 10.1007/s00464-023-10462-7. Epub 2023 Oct 5.
Laparoscopic splenectomy (LS), a treatment for both benign and malignant splenic diseases, can prove technically challenging in patients with massive splenomegaly. In particular, the optimal surgical modality for treating massive splenomegaly in children remains controversial.
The clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression.
The total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378).
For pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.
腹腔镜脾切除术（LS）可治疗良性和恶性脾脏疾病，对于巨脾患者可能具有挑战性。特别是，治疗儿童巨脾的最佳手术方式仍存在争议。
回顾性分析 289 例巨脾行脾切除术患儿的临床病理资料。根据手术方式将患者分为 LS 手术组和开腹脾切除术（OS）手术组。腹腔镜组根据手术方式分为多孔腹腔镜脾切除术（MILS）和单孔腹腔镜脾切除术（SILS）组。分析患者的一般资料、临床资料、手术方式、并发症及术后恢复情况。同时采用单因素和多因素逻辑回归分析比较腹腔镜脾切除术不良结局的风险。
OS 组的总手术时间明显短于 LS 组（149.87±61.44 分钟比 188.20±52.51 分钟，P<0.001）。与 OS 组相比，LS 组术后疼痛评分、肠道恢复时间和术后住院时间较低（P<0.001）。两组术后并发症和死亡率差异无统计学意义（P>0.05）。然而，SILS 手术组的手术时间明显长于 MILS 手术组（200±46.11 分钟比 171.39±40.30 分钟，P=0.02）。同时，MILS 和 SILS 的手术时间与脾脏长度呈显著正相关。此外，SILS 的手术时间与患儿的年龄、体重和身高呈显著正相关。脾脏长度是不良结局的独立危险因素（P<0.001，OR 1.378）。
对于能够耐受长时间麻醉和手术的儿童巨脾患者，LS 手术是最佳治疗方案。SILS 仍是一种新的手术治疗方法，可作为治疗巨脾的替代手术方法。
