Hebra A, Walker J D, Tagge E P, Johnson J T, Hardee E, Othersen H B
Department of Surgery, Medical University of South Carolina, Charleston 29425-2270, USA.
Am Surg. 1998 Dec;64(12):1161-4.
Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, splenomegaly, and recurrent sequestration. Over the last 6 months, we have developed a new technique for laparoscopic splenectomy (LS) for hypersplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the average weight was 18.7 kg (range, 13.2-30.1). On preoperative ultrasound, spleen size index ranged from 0.42 to 0.76. For the LS, four trochars were placed. One patient, who also underwent a laparoscopic cholecystectomy, had six trochars placed, two of which were used for both cholecystectomy and splenectomy. After laparoscopic mobilization of the spleen and hilar vascular stapling, a Steiner electromechanical morcellator was inserted through the 12-mm port to extract cores of splenic tissue until complete splenectomy was achieved. No patient required conversion to an open procedure or creation of a larger incision to remove the massively enlarged spleen. Operative time averaged 190 minutes; the combined LS and cholecystectomy took 245 minutes. Postoperative length of stay was <2 days for all patients. There were no complications, and no patient required postoperative transfusion. Based on these early findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleens in small children. It provides expedient recovery and minimal postoperative pain and scarring. This new technique should enable surgeons to perform LS even in patients with massive splenomegaly, eliminating the need for large and cumbersome intracorporeal bags or the creation of additional incisions to remove the spleen.
脾切除术适用于多种血液系统疾病，对于患有镰状细胞病、脾肿大和反复脾滞留的儿童而言，该手术可能极具挑战性。在过去6个月里，我们为5名患有镰状细胞病的儿童开发了一种用于治疗脾功能亢进和脾肿大的腹腔镜脾切除术（LS）新技术。我们患者的平均年龄为6岁（范围2 - 11岁），平均体重为18.7千克（范围13.2 - 30.1千克）。术前超声检查显示，脾脏大小指数在0.42至0.76之间。对于腹腔镜脾切除术，放置了4个套管针。1名同时接受腹腔镜胆囊切除术的患者放置了6个套管针，其中2个用于胆囊切除术和脾切除术。在腹腔镜下将脾脏游离并进行脾门血管吻合器离断后，通过12毫米的端口插入施泰纳电动组织粉碎器，提取脾组织碎块，直至完成脾切除术。没有患者需要转为开放手术或扩大切口来切除巨大的脾脏。手术时间平均为190分钟；腹腔镜脾切除术和胆囊切除术联合手术耗时245分钟。所有患者术后住院时间均<2天。没有出现并发症，也没有患者需要术后输血。基于这些早期发现，我们得出结论，脾组织的体内碎块化处理能够安全、完整地通过腹腔镜切除小儿的巨大脾脏。它能使患者快速康复，术后疼痛和疤痕最小化。这项新技术应能使外科医生即使在患有巨大脾肿大的患者中也能进行腹腔镜脾切除术，无需使用大型且笨重的体内袋子或额外扩大切口来切除脾脏。
