比较腹腔镜与开腹脾切除术在治疗儿童血液病的应用  

Comparison of laparoscopic versus open splenectomy for hematologic diseases

作　　者：顾志成[1] 朱雪明[1] 吴缤[1] 朱杰[1] 陈建雷[1] 黄顺根[1] 汪健[1] 孙庆林[1] 

机构地区：[1]苏州大学附属儿童医院外科,215003

出　　处：《中华小儿外科杂志》2014年第6期439-443,447,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨应用腹腔镜脾切除术（laparoscopic splenectomy，LS）和开腹脾切除术（open splenectomy，OS）治疗儿童血液病的临床疗效。方法回顾2003年1月至2013年11月行脾切除治疗儿童血液病73例的临床资料。按手术方法不同，将其中35例腹腔镜脾切除术（LS组）与38例开腹脾切除术（OS组）进行对比分析。两组术后随访1个月～10年。结果LS组与0S组均完成手术。LS组有33例患儿成功实施脾切除术，2例小切口辅助中转开腹手术。LS组和os组平均手术时间分别为（126±38）min和（100±45）min，术中平均出血量为（36．7±20．6）ml和（33．2±16．8）ml，术后平均恢复饮食的时间约为1．5d和112．5d，副脾发现率分别为42．8％（15／35）和31．5％（12／38）。两组比较，平均手术时间和术后恢复饮食的时间差异均有统计学意义（P〈0．05）。LS组术后并发症发生率为8．6％（3／35），OS组为13．2％（5／38）。LS组治疗血液病长期疗效和OS组相似。结论①小儿腹腔镜脾切除术切实可行、安全有效，LS可替代OS成为治疗儿童良性血液病的措施。②LS与OS相比具有副脾发现率高、创伤小、术后恢复快、并发症少、伤口小而美观等优点。Objective To compare laparoscopic splenectomy （LS） versus open splenectomy （OS） for the treatment of hematologic diseases in children. Methods Retrospective reviews were conducted for the clinical records of 73 children undergoing splenectomy for hematologic diseases at our institution during January 2003 to November 2013. According to different operative approaches, LS （n = 35） and OS （n = 38） were assigned and compared. The follow-up period was 1 month to 10 years. Results Both groups underwent splenectomy. A total of 33 total LS were performed successfully, Conversion was performed with small incision in 2 patients. The average operative duration was （126 ± 38） min for LS versus （100± 45） min for OS （P〈0. 05） ; average intraoperative blood loss （36, 7 ±20. 6） ml for LS versus （33.2± 16. 8） ml for OS （P〈0. 05）. Time to resumption of oral intake averaged 1.5 days for LS and 2. 5 days for OS （P〈0. 05）. The incidence of accessory spleens was 42. 8% for LS and 31.5% for OS. The postoperative complications were 8.6% for LS and 13.2% for OS respectively. The long-term efficacies of LS and OS were similar in the management of hematologic diseases. Conclusions LS is feasible, efficacious and safe for hematological diseases in children. It offers many advantages of mini-invasiveness, quick recovery, fewer postoperative complications and a higher discovery rate of accessory spleens over OS.

关 键 词：腹腔镜检查 脾切除术 血液病 

分 类 号：R726.5[医药卫生—儿科]