经脐单切口腹腔镜脾切除术  

Initial experience of transumbilical single incision laparoscopic splenectomy

作　　者：于增文[1] 牛忠[2] 李索林[1] 孙驰[1] 许书清[2] 李英超[1] 马亚贞[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000 [2]邢台市人民医院普外二外科

出　　处：《中华小儿外科杂志》2011年第7期495-497,共3页Chinese Journal of Pediatric Surgery

基　　金：基金项目：河北省医学适用技术跟踪项目（编号：GL2010-14）

摘　　要：目的总结儿童经脐单切口腹腔镜脾切除术的初步经验，并探讨其可行性和安全性。方法回顾分析2010年4月至2011年1月期间5例脾相关疾病儿童经脐单切口入路腹腔镜脾切除术的临床资料，男3例，女2例，年龄4～12岁，包括遗传性球形红细胞增多症3例和特发性血小板减少性紫癜2例。我们使用自行改进的三通道套管和弯曲器械，超声刀切断脾周围韧带，切割钉合器或生物夹处理脾蒂，脾脏从单切口取出。结果5例腹腔镜脾切除术均经脐单切口人路获得成功，没有中转常规腹腔镜手术。手术时间125~220min，估计术中出血量10~30ml，无围手术期并发症，术后5～8d痊愈出院。随访3～12个月，5例患儿均生长发育良好，贫血得到纠正，血小板计数正常。结论经脐单切口腹腔镜脾切除术较常规腹腔镜脾切除术对腹壁创伤更小、美容效果更好，可在儿童安全实施；但需要更多数量和进一步前瞻性研究来评价其真正益处。Objective To review our initial experience of transumbilical single incision laparo- scopic splenectomy in children and to assess the feasibility and safety of this laparoscopic procedures. Methods Clinical data of 5 children who underwent laparoscopic splenectomy via a single umbilical in- cision between April 2010 and January 2011 were reviewed. There were 3 boys and 2 girls. The age ranged from 4 to 12 years. Of them,3 cases suffered from hereditary spherocytosis and 2 cases from id- iopathic thrombocytopenic purpura. We used the Tri-port and self-modified curved instruments. The splenic attachments were taken down using the harmonic scalpel, and the hilum was clipped with Hem- o-lok or transected with Endo-GIA. The spleen was removed from the abdomen via the single incision. Results All of the laparoscopic splenectomies were completed successfully with transumbilical single incision approach without conversion to conventional laparoscopic surgery. The operation time ranged from 125 to 220 min and the estimated blood loss was 10-30ml. There were no perioperative complica- tions. All patients recovered that the postoperative hospital stay was 5 8 days. During a follow-up peri- od of 3 to 12 months, all children were very well with improved growth and normal hemotology. Con- clusions Compared with standard laparoscopic splenectomy, transumbilical single incision laparoscopic splenectomy may reduce surgical trauma, and improve cosmesis. A large prospective trial will be necessary to assess the true benefit of this approach.

关 键 词：腹腔镜外科手术 脾切除术 

分 类 号：R726.5[医药卫生—儿科]