Fitzgerald P G, Langer J C, Cameron B H, Park A E, Marcaccio M J, Walton J M, Skinner M A
Children's Hospital, Chedoke-McMaster, 1200 Main St. W., Hamilton, ON L8N 325, Canada.
Surg Endosc. 1996 Aug;10(8):859-61. doi: 10.1007/BF00189553.
Laparoscopic splenectomy in children has been shown to be safe, to reduce postoperative pain and hospital stay, and to accelerate return to full activities. We describe our experience with a four-port "lateral" approach in 18 patients. Patients were placed in the lateral decubitus position and the table was flexed to separate the left subcostal margin and iliac crest. The camera port was inserted at the umbilicus and additional ports were placed in the epigastrium and left lower quadrant. After mobilization of the splenic flexure a port was inserted in the left flank below the 12th rib for elevation of the spleen. A 30 degrees laparoscope was used and the splenic vessels were controlled with an endo-GIA and/or clips. The spleens were placed in a bag, morcellated, and extracted through a port site. Eight females and 10 males with a median age of 12.5 years (5-17 years) and weight of 55.5 kg (17-124 kg) underwent splenectomy of idiopathic thrombocytopenia purpora (10), spherocytosis (6), elliptocytosis (1), and Hodgkin's disease (1). The median operating time was 160 min (90-300 min) and median blood loss was 105 ml (5-350 ml). Accessory spleens were removed in four cases. Three patients required extensions of a port site to remove large spleens which could not be placed in a bag. The sole complication was a transient pancreatitis with associated pleural effusion. The median postoperative hospital stay was 2 days (1-11 days) and time to full activities was 8 days (3-25 days). The lateral approach affords excellent visualization of the splenic vessels, pancreas, and accessory spleens. This approach is safe and reliable and is our preferred approach for laparoscopic splenectomy in children.
腹腔镜脾切除术已被证明对儿童是安全的，可减轻术后疼痛、缩短住院时间，并加速全面恢复活动。我们描述了我们对18例患者采用四孔“外侧”入路的经验。患者取侧卧位，手术台弯曲以分开左肋下缘和髂嵴。摄像头端口插入脐部，额外的端口置于上腹部和左下腹。游离脾曲后，在第12肋下方的左腰部插入一个端口以提起脾脏。使用30度腹腔镜，用内镜切割吻合器和/或钛夹控制脾血管。脾脏装入袋中，切碎后通过一个端口部位取出。8名女性和10名男性，中位年龄12.5岁（5 - 17岁），体重55.5千克（17 - 124千克），接受了特发性血小板减少性紫癜（10例）、球形红细胞增多症（6例）、椭圆形红细胞增多症（1例）和霍奇金病（1例）的脾切除术。中位手术时间为160分钟（90 - 300分钟），中位失血量为105毫升（5 - 350毫升）。4例患者切除了副脾。3例患者需要扩大端口部位以取出无法装入袋中的大脾脏。唯一的并发症是短暂性胰腺炎伴胸腔积液。术后中位住院时间为2天（1 - 11天），全面恢复活动的时间为8天（3 - 25天）。外侧入路能很好地显露脾血管、胰腺和副脾。这种方法安全可靠，是我们儿童腹腔镜脾切除术的首选方法。
