Esposito C, Corcione F, Ascione G, Garipoli V, Di Pietto F, De Pasquale M
Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
Surg Endosc. 1998 Dec;12(12):1445-8. doi: 10.1007/s004649900879.
We set out to analyze the results of the first 19 laparoscopic splenectomies performed by our team in order to show the advantages and limitations of the laparoscopic approach to this kind of procedure in children.
Between March 1994 and June 1997, 19 children underwent laparoscopic splenectomy; two of them also had a concomitant cholecystectomy. Their ages ranged between 4 and 14 years (median, 7.2 years). There were 14 girls and 5 boys. All the patients underwent elective laparoscopic splenectomy: seven children had hereditary spherocytosis, six were affected by a beta thalassemia, five had an idiopathic thrombocytopenia purpura, and one presented with sickle cell disease.
Mean operating time was 145 min (range, 110-240 min). Hospital stay ranged from 2 to 5 days (median, 3 days). In three patients, the spleen was removed with a 7-cm mini-laparotomy, according to the technique of Pfannenstiell, in the suprapubic region. In the other 16 cases, the spleen was captured into a extraction bag, finger-fragmented, and removed from the umbilical orifice.
Laparoscopic splenectomy can be performed only when the spleen can be removed through the umbilical orifice with an extraction bag. For this reason, preoperative ultrasonography is necessary to measure the exact spleen volume. When the spleen is very large, an open splenectomy is preferable.
我们着手分析本团队开展的首例19例腹腔镜脾切除术的结果，以展示腹腔镜手术治疗儿童此类疾病的优势和局限性。
1994年3月至1997年6月，19例儿童接受了腹腔镜脾切除术；其中2例同时进行了胆囊切除术。他们的年龄在4至14岁之间（中位数为7.2岁）。有14名女孩和5名男孩。所有患者均接受择期腹腔镜脾切除术：7例儿童患有遗传性球形红细胞增多症，6例患有β地中海贫血，5例患有特发性血小板减少性紫癜，1例患有镰状细胞病。
平均手术时间为145分钟（范围为110 - 240分钟）。住院时间为2至5天（中位数为3天）。3例患者根据Pfannenstiell技术在耻骨上区域通过7厘米的小剖腹术切除脾脏。在其他16例病例中，脾脏被装入提取袋，用手指破碎后从脐孔取出。
只有当脾脏能够通过脐孔用提取袋取出时，才能进行腹腔镜脾切除术。因此，术前超声检查对于准确测量脾脏体积是必要的。当脾脏非常大时，开腹脾切除术更为可取。
