Xiang Qiangxing,Li Yong,Liu Denghui,et al.Retrospective analysis of laparoscopic partial splenectomy: results of 8 consecutive cases in children[J].Journal of Clinical Pediatric Surgery,2023,22(01):28-31.[doi:10.3760/cma.j.cn101785-202210065-006]
腹腔镜下脾脏部分切除术治疗儿童脾脏肿瘤
- Title:
- Retrospective analysis of laparoscopic partial splenectomy: results of 8 consecutive cases in children
- Keywords:
- Laparoscopes; Spleen; Neoplasms; Splenic pedicle; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨儿童脾脏肿瘤行腹腔镜下脾脏部分切除术的安全性及可行性。方法 回顾性分析2012年8月至2022年8月湖南省儿童医院普外科收治的8例行腹腔镜下脾脏部分切除术患儿临床资料,主要观察指标包括肿瘤最大长径、手术时间、术中出血量、术后住院时间及术后并发症。结果 8例患儿年龄6岁10个月至15岁4个月,中位年龄10岁9个月;肿瘤最大长径(7.7±4.1)cm,均顺利完成腹腔镜下脾脏部分切除术,无一例中转开腹手术,其中脾上段切除2例,脾下段切除5例,脾中断切除1例;手术时间(230.9±58.2)min,术中出血量(162.5±145.8)mL,术后住院时间(9.6±2.3)d。术后病理结果:4例脾囊肿,3例脾淋巴管瘤,1例脾血管瘤。1例术后出现腹腔出血,经输血、止血等对症保守治疗后好转;2例术后出现血小板升高,予口服双嘧达莫片预防血栓形成,术后1个月血小板恢复正常。无一例出现感染、静脉血栓、残脾梗死等并发症。随访6~24个月,无一例肿瘤复发。结论 腹腔镜下脾脏部分切除术治疗儿童脾脏良性肿瘤安全可行,可保留正常脾脏功能,术中对二级脾蒂的处理是关键。
- Abstract:
- ObjectiveTo explore the safety and feasibility of laparoscopic partial splenectomy for splenic tumors in children.MethodsFrom August 2012 to August 2022,clinical data were retrospectively reviewed for 8 hospitalized children undergoing laparoscopic partial splenectomy.ResultsLaparoscopic partial splenectomy was successfully performed in all 8 cases without any conversion into open surgery.There were upper splenectomy (n=2),lower splenectomy (n=5) and interrupted splenectomy (n=1).Median age was 129(82-184) months,maximal tumor diameter (7.7±4.1) cm,operative duration (230.9±58.2) min,intraoperative blood loss (162.5±145.8) mL and postoperative hospital stay (9.6±2.3) days.Postoperative abdominal hemorrhage improved in 1 case after such symptomatic conservative measures as blood transfusion and hemostasis.Platelet elevation occurred in 2 cases and oral dipyridamole tablets were given to prevent thrombosis.And platelet normalized at 1 month post-operation;Postoperative pathologies included splenic cysts (n=4),lymphangiomas (n=3) and hemangioma (n=1).There were no postoperative complications such as infection,venous thrombosis or residual splenic infarction.No tumor recurrence occurred during a follow-up period of 6 to 24 months.ConclusionLaparoscopic partial splenectomy is both safe and feasible benign splenic tumors in children.It may preserve the function of normal spleen.A proper intraoperative management of secondary splenic pedicle is essential.
参考文献/References:
[1] 展翰翔,徐建威,胡三元.腹腔镜部分脾切除术的手术策略与技巧[J].腹腔镜外科杂志,2016,21(8):570-572.DOI:10.13499/j.cnki.fqjwkzz.2016.08.570. Zhan HX,Xu JW,Hu SY.Surgical strategies and techniques of laparoscopic partial splenectomy[J].J Laparosc Surg,2016,21(8):570-572.DOI:10.13499/j.cnki.fqjwkzz.2016.08.570.
[2] King H,Shumacker HB Jr.Splenic studies.I.Susceptibility to infection after splenectomy performed in infancy[J].Ann Surg,1952,136(2):239-242.DOI:10.1097/00000658-195208000-00006.
[3] Balaphas A,Buchs NC,Meyer J,et al.Partial splenectomy in the era of minimally invasive surgery:the current laparoscopic and robotic experiences[J].Surg Endosc,2015,29(12):3618-3627.DOI:10.1007/s00464-015-4118-9.
[4] Delaitre B,Maignien B,Icard P.Laparoscopic splenectomy[J].Br J Surg,1992,79(12):1334.DOI:10.1002/bjs.1800791230.
[5] 吴荣德,陈新国,于启海,等.腹腔镜在小儿脾切除术中的应用[J].中华小儿外科杂志,2003,24(6):522-525.DOI:10.3760/cma.j.issn.0253-3006.2003.06.014. Wu RD,Chen XG,Yu QH,et al.Application of laparoscopic splenectomy in children[J].Chin J Pediatr Surg,2003,24(6):522-525.DOI:10.3760/cma.j.issn.0253-3006.2003.06.014.
[6] Rosman CWK,Broens PMA,Trzpis M,et al.A long-term follow-up study of subtotal splenectomy in children with hereditary spherocytosis[J].Pediatr Blood Cancer,2017,64(10):e26592.DOI:10.1002/pbc.26592.
[7] 刘登辉,李勇,唐湘莲,等.儿童脾脏淋巴管瘤七例并文献复习[J].腹部外科,2021,34(3):223-227,43.DOI:10.3969/j.issn.1003-5591.2021.03.012. Liu DH,Li Y,Tang XL,et al.Splenic lymphangioma in children:a report of seven cases with a literature review[J].J Abdom Surg,2021,34(3):223-227,243.DOI:10.3969/j.issn.1003-5591.2021.03.012.
[8] 尹强,彭宇明,谢惟心,等.小儿腹腔镜保脾胰腺体尾部切除手术七例[J].临床小儿外科杂志,2021,20(7):627-630.DOI:10.12260/lcxewkzz.2021.07.006. Yin Q,Peng YM,Xie WX,et al.Experience of laparoscopic resection of spleen-preserving pancreatic body and tail in children[J].J Clin Ped Sur,2021,20(7):627-630.DOI:10.12260/lcxewkzz.2021.07.006.
[9] Redmond HP,Redmond JM,Rooney BP,et al.Surgical anatomy of the human spleen[J].Br J Surg,1989,76(2):198-201.DOI:10.1002/bjs.1800760230.
[10] 莫锋,蔡辉华,陈学敏,等.超声刀联合双极电凝在腹腔镜脾脏部分切除术中的应用[J].中华肝胆外科杂志,2014,20(10):756-757.DOI:10.3760/cma.j.issn.1007-8118.2014.10.019. Mo F,Cai HH,Chen XM,et al.Application of ultrasonic knife plus bipolar electrocoagulation in laparoscopic partial splenectomy[J].Chin J Hepatobiliary Surg,2014,20(10):756-757.DOI:10.3760/cma.j.issn.1007-8118.2014.10.019.
[11] Godiris-Petit G,Goasguen N,Munoz-Bongrand N,et al.Laparoscopic partial splenectomy using the Harmonic Scalpel.Two case reports[J].J Chir (Paris),2007,144(4):339-341.DOI:10.1016/s0021-7697(07)91966-3.
[12] 郝龙,沙洪存.腹腔镜脾脏部分切除术治疗脾良性肿瘤的体会[J].肝胆胰外科杂志,2020,32(7):423-425.DOI:10.11952/j.issn.1007-1954.2020.07.008. Hao L,Sha HC.Laparoscopic partial splenectomy for benign splenic tumors[J].Journal of Hepatopancreatobiliary Surgery,2020,32(7):423-425.DOI:10.11952/j.issn.1007-1954.2020.07.008.
[13] 王颖,李峰.保留脾脏功能的腹腔镜胰体尾手术-Kimura法的初步探讨[J].腹腔镜外科杂志,2022,27(3):165-170.DOI:10.13499/j.cnki.fqjwkzz.2022.03.165. Wang Y,Li F.Laparoscopic pancreatectomy with splenic function preservation:a preliminary study of Kimura method[J].J Laparosc Surg,2022,27(3):165-170.DOI:10.13499/j.cnki.fqjwkzz.2022.03.165.
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备注/Memo
收稿日期:2022-10-31。
基金项目:国家临床重点专科建设项目-湖南省儿童医院小儿外科(湘卫医发[2022]2号);湖南省临床医疗技术创新引导项目(2020SK50501)
通讯作者:李勇,Email:liyongpuwaike@163.com