Sato Alma, Alogakos Marios, Burns James W F, Roberts Megan, Grammenou Dafni-Stravroula, Ghotra Ebaney, Lugard Emily E, Chidiac Charbel, Than Christian Aloysius, Nakanishi Hayato, Kunisaki Shaun M
University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus.
St George's University of London, London, SW17 0RE, UK.
Pediatr Surg Int. 2025 Oct 17;41(1):317. doi: 10.1007/s00383-025-06208-2.
Laparoscopic splenectomy (LS) is the preferred surgical approach for pediatric patients requiring splenectomy, though gaps remain regarding spleen size impact on outcomes and conversion rates, especially in children with hematologic disorders.
A comprehensive literature search was conducted across PubMed, Medline, CINAHL, Embase, and Cochrane Library, from inception to January 2025, following PRISMA guidelines and registered with PROSPERO (CRD42025644989). Statistical analysis was performed using a random-effects model.
The initial search yielded 216 studies, 19 studies with 1898 pediatric patients included. Of those, 1202 underwent LS and 696 open splenectomy (OS). LS was associated with shorter hospital stay (MD: -1.59 days, 95% CI: -2.18 to -1.00, P < 0.00001), faster initiation of oral feeding (MD: -0.68 days, 95% CI: -1.07 to -0.29, P = 0.0006), fewer transfusions (OR = 0.38, 95% CI: 0.23 to 0.62, P = 0.0001), and conversion to OS in 2.7% of cases. OS showed shorter operative time (MD: 60.4 min, 95% CI: 37.4 to 83.4, P < 0.00001), and improved accessory spleen removal (OR: 1.91, 95% Cl: 1.02 to 3.57, P = 0.04).
Our findings support LS as a safe and effective technique in pediatric hematologic patients and provide updated evidence to guide surgical decision-making.
腹腔镜脾切除术（LS）是需要脾切除的儿科患者的首选手术方法，不过关于脾脏大小对手术结果和中转率的影响仍存在差距，尤其是在患有血液系统疾病的儿童中。
按照PRISMA指南，从创刊至2025年1月，在PubMed、Medline、CINAHL、Embase和Cochrane图书馆进行了全面的文献检索，并在PROSPERO（CRD42025644989）注册。使用随机效应模型进行统计分析。
初步检索得到216项研究，纳入19项研究共1898例儿科患者。其中，1202例行LS，696例行开放性脾切除术（OS）。LS与住院时间缩短（MD：-1.59天，95%CI：-2.18至-1.00，P<0.00001）、开始经口喂养更快（MD：-0.68天，95%CI：-1.07至-0.29，P=0.0006）、输血次数减少（OR=0.38，95%CI：0.23至0.62，P=0.0001）相关，2.7%的病例中转至OS。OS显示手术时间较短（MD：60.4分钟，95%CI：37.4至83.4，P<0.00001），副脾切除改善（OR：1.91，95%Cl：1.02至3.57，P=0.04）。
我们的研究结果支持LS作为儿科血液系统疾病患者的一种安全有效的技术，并提供了最新证据以指导手术决策。
