小儿巨脾切除腹腔镜与开腹的对比分析  

Laparoscopic versus open splenectomy for the treatment of massive splenomegaly in children

作　　者：谢志杰[1] 朱锦辉[1] 叶环[2] 占小莉[1] 王跃东[1] 

机构地区：[1]浙江省人民医院微创外科,杭州310014 [2]杭州师范学院医学院附属医院

出　　处：《中华小儿外科杂志》2012年第7期484-487,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨腹腔镜小儿巨脾切除术（LS）的安全性和有效性。方法定义小儿脾脏下缘过脐平面，内侧缘过中线为小儿巨脾。按此定义回顾性分析1997年4月至2011年10月同一治疗组诊治的25例腹腔镜小儿巨脾切除和同期的21例开腹巨脾切除（（）P）病例，对比手术时间、术中出血、住院时间、脾脏大小等资料。结果腹腔镜中转开腹1例，其余24例LS顺利完成。腹腔镜与开腹平均手术时间为（69．0±34．5）min和（66．0±41．3）min，两者无统计学差异（P〉0．05），其中脾脏游离时间（48．5±24．5）min和（57．8±29．1）min；术中出血（64．0±26．4）ml和（92．8±48．6）ml，住院时间（3．6±2．O）d和（5．8±2．7）d；两者具有统计学差异（P〈0．01）；脾脏大小为（19．2±7．4）cm和（18．3±7．9）cm，两者无统计学差异（P〉O．05）。术后并发症发生率分别为12．0%,40和33．3％。结论腹腔镜小儿巨脾切除术是安全、有效、切实可行的，能缩短住院时间，减少术后并发症。Objective compare laparoscopic splenectomy with open splenectomy for the treat- ment of splenomegaly in children. Methods Splenomegaly was defined when splenic margin was below the umbilicus or extended over the midline. According to this criteria, 46 patients who underwent splenectomy for massive splenomegaly at this center between April 1997 and Oct 2011 were enrolled in this study. Of the patients, 25 underwent laparoscopic splenectomy, and the other 21 were performed open splenectomy. Clinical data including operative time, bleeding, spleen size, complications and the length of hospital stay was retrospectively analyzed. ResultsOne patient was converted to open surgery due to uncontrollable bleeding more than 200 ml during laparoscopic splenectomy. The other 25 cases were performed taparoscopic splenectomy successfully. No death, wound infection, and pancreatitis was noted. No significant difference of operation time was found between laparoscopic splenectomy and open splenectomy （69. 0 ± 34. 5 min vs 66. 0 ± 41.3 min, P〉0. 05）. However, spleen dissection time in laparoscopie splenectomy was shorter compared with that in open surgery （48. 5± 24. 5 rain vs 57. 8±29. 1 rain, P〈0. 05）. Bleeding in laparoscopic splenectomy was also less than that in open sur gery （64. 0 ± 26. 4 ml vs 92. 8 ± 48. 6 ml, P〈0. 01）. No significant difference of spleen size was found between laparoscopie spleneetomy and open splenectomy （19. 2 ± 7. 4 cm vs 18. 3 ± 7. 9 era, P〉0. 05）. The length of hospital stay of the patients with laparoscopic splenectomy was shorter （3.6 ± 2. 0 days vs 5.8± 2. 7 days, P〈0. 01）. No accessory spleen were missed in laparoscopic splenectomy, while accessory spleens were missed in 2 patients with open splenectomy. The postoperative complication rate of the patients with laparoscopic surgery and open surgery was 12. 0% and 33.3% respectively. Conclusions Laparoseopic splenectomy for massive is a safe and effective procedure for the treatment of splenomegaly in childr

关 键 词：腹腔镜外科手术 脾切除术 

分 类 号：R726[医药卫生—儿科]