腹腔镜治疗未成年人非寄生虫性脾囊肿的手术方式  

Laparoscopic Treatment of Nonparasitic Splenic Cysts in Minors

作　　者：谢潭 张大[1] 杨合英[1] 张春英[1] 杨林[1] 赵鸽[1] 贾佳[1] XIE Tan;ZHANG Da;YANG Heying;ZHANG Chunying;YANG Lin;ZHAO Ge;JIA Jia(Pediatric Surgery Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院小儿外科,河南郑州450000

出　　处：《河南医学研究》2024年第12期2214-2218,共5页Henan Medical Research

摘　　要：目的 探讨如何选择腹腔镜治疗未成年人非寄生虫性脾囊肿的手术方式及其优缺点。方法 收集2012年7月至2023年7月郑州大学第一附属医院15例行腹腔镜脾囊肿手术的患者临床资料。统计分析腹腔镜下脾脏切除术(LTS),腹腔镜下脾脏部分切除术(LPS),腹腔镜下脾囊肿去顶减压毁底术(LTDSC)患者的年龄、囊肿位置及大小、手术时间、术中出血量、病理结果、术后血小板计数、腹腔引流管留置时间、术后住院时间、术后并发症、出院后影像学随访结果等相关指标。结果 LTS 6例,LPS 4例,LTDSC 5例。LPS中1例因术中损伤脾门血管出血较多,手术方式转为LTS。LPS和LTS中均有1例因术中出血较多,给予输注红细胞悬液1个单位。术后病理结果:脾囊肿13例,囊性畸胎瘤2例。LPS中1例患者术后腹腔出血,给予止血药物应用后症状缓解。LTS中4例患者术后出现血小板骤升,给予口服双嘧达莫片预防血栓形成,1个月后血小板降至正常。LTS中1例患者术后脐部切口感染,给予抗感染、清洁换药后好转。术后复发2例,时间为术后2个月和4 a,均为LTDSC,术后病理结果为脾囊肿,再次行LPS。结论 LPS治疗未成年人脾囊肿的术后并发症和复发率低,囊肿位于脾门处的保脾手术可选择LTDSC,对于多发囊肿及囊肿合并感染的患者可选择LTS。Objective To explore how to choose the laparoscopic treatment of non-parasitic splenic cysts in minors.Methods The clinical data of 15 pediatric patients who underwent laparoscopic splenic cyst surgery in the First Affiliated Hospital of Zhengzhou University from July 2012 to July 2023 were collected.The age,location and size of cysts,operative duration,intraoperative blood loss,pathological diagnosis,postoperative platelet count,postoperative catheterization time,postoperative complication,postoperative hospital stay and imaging follow-up results were subjected to statistical analysis among laparoscopic total splenectomy(LTS),laparoscopic partial splenectomy(LPS)and laparoscopic topside decompression for splenic cyst(LTDSC).Results There were 6 cases in LTS,4 cases in LPS and 5 cases in LTDSC.LTS was performed in a case of LPS due to intraoperative injury of splenic hilar vessels.In both LPS and LTS,one patient was injected with one unit of red cell suspension due to excessive intraoperative bleeding.Postoperative pathological results:13 cases of splenic cyst,2 cases of cystic teratoma.One patient with LPS had abdominal hemorrhage after operation,and the symptoms were relieved after the administration of hemostatic drugs.Four patients with LTS experienced sudden thrombocytosis after operation,and the platelet decreased to normal after a month of oral dipyridamole tablets for prevention of thrombosis.A case of umbilical incision infection in LTS was improved after anti-infection,cleaning and dressing changed.Postoperative recurrence was observed in two cases,occurring 2 months and 4 years after LTDSC.The pathological result was the splenic cyst,and then LPS was performed.Conclusion LPS has a low rate of postoperative complications and recurrence in the treatment of juvenile splenic cysts.The cyst located at the splenic hilum can be selected by LTDSC.LTS is an option for patients with multiple splenic cysts and cyst infection.

关 键 词：囊肿 脾 手术方式 未成年人 

分 类 号：R726.1[医药卫生—儿科]