应用直线切割闭合器行腹腔镜原位脾切除术治疗儿童血液病所致脾功能亢进的临床研究  

Clinical analysis of laparoscopic splenectomy for hypersplenism caused by hematologic diseases in children

作　　者：王建尧[1] 劳京 王焕生 罗玉 郑粤兰 刘冬[1] 郭敬杰 麻晓鹏[1] 王斌[1] Wang Jianyao;Lao Jing;Wang Huansheng;Luo Yu;Zheng Yuelan;Liu Dong;Guo Jingjie;Ma Xiaopeng;Wang Bin(Ward II of General Surgery,Municipal Children's Hospital,Shenzhen 518026,China;Shenzhen Children's Hospital,China Medical University,Shenzhen 518026,China;Zhuhai Campus,Zunyi Medical College,Zhuhai 519000,China)

机构地区：[1]深圳市儿童医院普外二病区,深圳518026 [2]中国医科大学深圳儿童医院,深圳518026 [3]遵义医科大学珠海校区,珠海519000

出　　处：《临床小儿外科杂志》2022年第7期617-621,共5页Journal of Clinical Pediatric Surgery

基　　金：广东省医学科研基金(A2020629);深圳市医疗卫生三名工程项目(SZSM201812055);深圳市医学重点学科建设基金(SZXK035)。

摘　　要：目的探讨应用直线切割闭合器行腹腔镜原位脾切除术治疗儿童血液病所致脾功能亢进的优势、可行性与安全性。方法选取2016年1月至2021年4月在深圳市儿童医院因血液病所致脾功能亢进行腹腔镜脾切除术的患儿作为研究对象,共32例,其中男13例,女19例,年龄5~16岁;包括地中海贫血28例,遗传性球形红细胞增多症4例。18例行传统腹腔镜下分束结扎脾蒂脾切除术(传统组),14例应用直线切割闭合器行腹腔镜下原位脾切除术(原位切闭器组)。比较两组患儿围手术期及术后并发症情况。结果32例患儿中,2例遗传性球形红细胞增多症患儿合并胆总管急性梗阻,行禁食、胃肠减压及抑酸抑酶好转,1个月后行脾切除手术治疗;其余30例患儿均顺利完成手术,无一例中转开腹患儿。围手术期,腹腔镜原位脾切除术组术后住院时间[(5.2±1.5)d]较传统组[(7.1±1.3)d]明显缩短(P<0.05),而两组术后肛门排气排便时间[(2.3±0.1)d比(2.1±0.8)d]、术后进食时间[(2.7±0.9)d比(2.2±0.2)d]、术后使用抗生素时间[(2.1±0.4)d比(2.4±0.3)d]差异均无统计学意义(P>0.05)。腹腔镜原位脾切除术组较传统组手术时间[(89±13)min比(192±26)min]、术中出血量[(18±2.6)mL比(51±2.8)mL]明显减少,差异有统计学意义(P<0.05)。术后随访发现:腹腔镜原位脾切除术组血红蛋白术前(76.21±5.5)g/L,术后1周(86.88±3.2)g/L,术后1个月(89.12±5.6)g/L,术后6个月(97.27±4.27)g/L,术后1年(118.25±13.36)g/L;传统组血红蛋白术前(76.21±5.5)g/L,术后1周(86.88±3.2)g/L,术后1个月(89.12±5.6)g/L,术后6个月(97.27±4.27)g/L,术后1年(118.25±13.36)g/L;两组差异无统计学意义(P>0.05)。腹腔镜原位脾切除术组血小板术前(435.12±44.86)×10^(9)/L,术后1周(764.27±33.42)×10^(9)/L,术后1个月(531.75±31.48)×10^(9)/L,术后6个月(528.42±21.63)×10^(9)/L;传统组血小板术前(431.28±32.33)×10^(9)/L,术后1周(745.88±25.38)×10^(9)/L,术后1个月(53Objective To explore the advantages,feasibility and safety of linear cutting closure device during laparoscopic splenectomy for hypersplenism caused by hematologic diseases in children.Methods From January 2016 to April 2021,32 children with hypersplenism caused by hematological diseases underwent laparoscopic splenectomy.There were 13 boys and 19 girls with an age range of 5 to 16 years.The causes were thalassemia(n=28)and hereditary spherocytosis(n=4).The procedures included traditional laparoscopic splenectomy with bundle ligation of splenic pedicle(n=18)and laparoscopic splenectomy in situ(n=14).The perioperative status and postoperative complications of two groups were compared.Results Two cases of hereditary spherocytosis complicated with acute obstruction of common bile duct improved through fasting,gastrointestinal decompression and acid and enzyme inhibition.And splenectomy was performed 1 month later.The remainders were successfully operated without any conversion into open surgery.Postoperative hospital stay was significantly shorter in laparoscopic in situ splenectomy group(P<0.05).Postoperative anal exhaust defecation time,postoperative eating time and postoperative antibiotic use time were basically similar in two groups and the differences were not statistically significant(P>0.05);laparoscopic in situ splenectomy group had shorter operative duration and lesser intraoperative blood loss.And the difference was statistically significant(P>0.05).In traditional laparoscopic group,two children received intraoperative infusion of 0.5 unit of red blood cell suspension.There was no severe fulminant infection.In traditional laparoscopic group,one child of portal vein thrombosis became relieved after thrombolytic therapy.Conclusion For pediatric hematological diseases,laparoscopic in situ splenectomy offers the advantages of simple handling,shorter operative duration,minimal trauma,less bleeding,faster postoperative recovery,fewer postoperative complications and shorter hospitalization stay.

关 键 词：脾切除术/方法 腹腔镜检查 脾功能亢进/外科学 治疗结果 儿童 

分 类 号：R726.5[医药卫生—儿科]