Xuan Xiaoxiao,Luo Wenjuan,Huang Zongwei,et al.Efficacy of robot-assisted laparoscopic partial splenectomy for benign splenic lesions in children[J].Journal of Clinical Pediatric Surgery,2026,(03):263-267.[doi:10.3760/cma.j.cn101785-202412068]
机器人辅助腹腔镜脾部分切除治疗儿童脾良性病变疗效分析
- Title:
- Efficacy of robot-assisted laparoscopic partial splenectomy for benign splenic lesions in children
- Keywords:
- Splenectomy; Splenic Diseases; Laparoscopy; Robotic Surgery; Child
- 摘要:
- 目的 探讨机器人辅助腹腔镜脾部分切除治疗儿童脾良性病变的安全性与临床疗效。方法 本研究为回顾性队列研究,回顾性分析2015年6月至2024年7月于浙江大学医学院附属儿童医院行腹腔镜或机器人辅助脾部分切除的23例儿童脾良性病变患儿的临床资料,评估两组手术效果及术后预后情况。结果 23例患儿中男12例、女11例,年龄10.50(8.00,12.08)岁;2例伴间歇性腹痛,4例脾囊肿并发感染,其中1例先行囊肿外引流术后延期行脾部分切除。病变最大径5.85(5.30,8.00)cm,位于上极/中上极9例、下极/中下极14例,均顺利完成切除,无一例中转开腹病例。5例行腹腔镜脾部分切除,18例行机器人辅助腹腔镜脾部分切除;机器人手术组中3例因病变跨越脾上下极行超选择性脾血管结扎,3例因病变巨大行脾动脉主干离断+保留胃短血管及脾膈韧带的脾大部分切除术。腹腔镜组与机器人组手术时间[185.00(167.00,198.50)min比147.00(111.50,172.25)min]、术中出血量[50.00(35.00,50.00)mL比20.00(13.75,31.25)mL]比较,差异均有统计学意义(P<0.05);术后住院时间[11.00(10.50,13.00)d比9.00(7.00,11.00)d]比较,差异无统计学意义(P>0.05)。术后病理示脾囊肿10例、淋巴管瘤6例、脾错构瘤4例,脾血管瘤、硬化性血管瘤样结节性转化、窦岸细胞血管瘤各1例。23例术后均无出血、残脾缺血、腹腔内感染、肠粘连、爆发性感染等并发症发生;平均随访23.4个月,未见病变复发,超声检查提示残脾体积呈增大趋势。结论 脾部分切除术治疗儿童脾良性病变安全、可靠;机器人辅助腹腔镜脾部分切除能显著缩短手术时间、减少术中出血量,更适合用于儿童脾部分切除手术。
- Abstract:
- Objective To evaluate the safety and clinical efficacy of robot-assisted laparoscopic partial splenectomy in the treatment of benign splenic lesions in children.Methods This retrospective cohort study analyzed the clinical data of 23 children with benign splenic lesions who underwent laparoscopic or robot-assisted laparoscopic partial splenectomy at the Childrens Hospital,Zhejiang University School of Medicine between June 2015 and July 2024.Surgical outcomes and postoperative prognosis were compared between the two groups.Results Among the 23 patients,12 were male and 11 were female,with a median age of 10.50 (8.00,12.08) years.Two patients presented with intermittent abdominal pain,and four had splenic cysts complicated by infection,including one patient who underwent external cyst drainage followed by delayed partial splenectomy.The maximum diameter of the lesions was 5.85 (5.30,8.00) cm.Nine lesions were located at the upper pole or upper-middle portion of the spleen,and fourteen at the lower pole or lower-middle portion.All procedures were completed successfully without conversion to open surgery.Five patients underwent laparoscopic partial splenectomy and eighteen underwent robot-assisted laparoscopic partial splenectomy.In the robotic surgery group,three patients underwent super-selective splenic vessel ligation due to lesions extending across the upper and lower poles of the spleen,and three patients with giant lesions underwent subtotal splenectomy by transection of the main splenic artery while preserving the short gastric vessels and the splenophrenic ligament.Compared with the laparoscopic group,the robotic group showed significantly shorter operative time[185.00 (167.00,198.50) min vs. 147.00 (111.50,172.25) min]and less intraoperative blood loss[50.00 (35.00,50.00) mL vs. 20.00 (13.75,31.25) mL](P<0.05).There was no significant difference in postoperative hospital stay between the two groups[11.00 (10.50,13.00) d vs.9.00 (7.00,11.00) d](P>0.05).Postoperative pathological examination revealed splenic cysts in 10 cases,lymphangiomas in 6 cases,splenic hamartomas in 4 cases,and one case each of splenic hemangioma,sclerosing angiomatoid nodular transformation and littoral cell angioma.No postoperative complications such as bleeding,residual splenic ischemia,intra-abdominal infection,intestinal adhesion,or overwhelming infection were observed.The mean follow-up period was 23.4 months,during which no recurrence was detected.Ultrasonography indicated a trend of increasing residual splenic volume.Conclusions Partial splenectomy is a safe and reliable treatment for benign splenic lesions in children.Robot-assisted laparoscopic partial splenectomy can significantly shorten operative time and reduce intraoperative blood loss,making it a preferable surgical approach for pediatric partial splenectomy.
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备注/Memo
收稿日期:2024-12-31。
基金项目:浙江省自然科学基金(LY20H030007)
通讯作者:陈青江,Email:chenqj0157@zju.edu.cn