Yoshida K, Yamazaki Y, Mizuno R, Yamadera H, Hara A, Yoshizawa J, Kanai M
First Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Surg Endosc. 1995 Dec;9(12):1279-82. doi: 10.1007/BF00190159.
To determine the safety and efficacy of laparoscopic splenectomy (LS) in children, a retrospective review of our preliminary experience using LS was compared to results in patients who previously underwent open splenectomy (OS). From July 1993 to January 1995, we performed eight LS procedures in six children with hereditary spherocytosis (HS) and two with immune thrombocytopenic purpura (ITP). Laparoscopic cholecystectomy was simultaneously done in one case with HS. There were 4 males and 4 females who ranged in age from 5 to 15 years--an average age of 8.8 years. Two cases in the early series required a counterincision because of bleeding. Eleven patients who previously underwent OS in our department were used to compare demographics, operative courses, and surgical outcomes. The ages, genders, diseases, body weights, and spleen weights were comparable between LS group and OS groups. The operative time for the LS group was statistically longer than for the OS group (226 +/- 24 min vs 101 +/- 8 min, P < 0.001). The estimated blood loss in the LS group was similar to that of the OS group (100 +/- 39 ml vs 73 +/- 11 ml. P = 0.97). There were no peri- or postoperative complications in two groups. The postoperative hospital stay of LS group was statistically shorter than that of the OS (6.8 +/- 0.6 days vs 10.4 +/- .05 days, P < 0.0001). LS provided better cosmesis and minimized trauma in children over OS. LS appears to be a safe and effective procedure in children, and is useful in the management of pediatric patients with HS or ITP.
为确定腹腔镜脾切除术（LS）在儿童中的安全性和有效性，我们对采用LS的初步经验进行了回顾性分析，并与先前接受开放性脾切除术（OS）的患者结果进行比较。1993年7月至1995年1月，我们对6例遗传性球形红细胞增多症（HS）患儿和2例免疫性血小板减少性紫癜（ITP）患儿实施了8例LS手术。1例HS患儿同时进行了腹腔镜胆囊切除术。患者共4男4女，年龄5至15岁，平均年龄8.8岁。早期系列中有2例因出血需要辅助切口。我们科室先前接受OS的11例患者用于比较人口统计学、手术过程和手术结果。LS组和OS组在年龄、性别、疾病、体重和脾脏重量方面具有可比性。LS组的手术时间在统计学上比OS组长（226±24分钟对101±8分钟，P<0.001）。LS组的估计失血量与OS组相似（100±39毫升对73±11毫升，P = 0.97）。两组均无围手术期或术后并发症。LS组的术后住院时间在统计学上比OS组短（6.8±0.6天对10.4±0.5天，P<0.0001）。与OS相比，LS在儿童中提供了更好的美容效果并使创伤最小化。LS似乎是一种在儿童中安全有效的手术方法，对患有HS或ITP的儿科患者的治疗很有用。
