儿童脾扭转诊治的单中心回顾性研究  

A single-center retrospective study on diagnosis and treatment of splenic torsion in children

作　　者：李拴玲 王大勇[2] 李云鹏 李现令[1] 谢方南 陈龙 黄柳明 Li Shuanling;Wang Dayong;Li Yunpeng;Li Xianling;Xie Fangnan;Chen Long;Huang Liuming(Department of Emergency Surgery,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China;Department of General Surgery,Baoding Hospital of Beijing Children's Hospital,Regional Center for Children's Health,Hebei,Baoding 071000,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院急诊外科,北京100045 [2]国家儿童区域医疗中心北京儿童医院保定医院普外科,河北保定071000

出　　处：《发育医学电子杂志》2024年第5期369-373,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：军委后勤保障部卫生局应用基础研究项目(21JSZ18)。

摘　　要：目的探讨儿童脾扭转的临床特点、诊疗及结局。方法收集2007年1月至2024年3月于首都医科大学附属北京儿童医院确诊为脾扭转(不包括副脾扭转)患儿的临床资料,包括患儿的一般资料、临床表现、影像学特点、手术中情况、术后并发症和治疗结局,并进行回顾性分析。结果共纳入19例患儿,其中男性5例,女性14例;年龄9~168个月,中位年龄71个月。腹痛(94.7%,18/19)是最常见的临床表现,其次为呕吐(57.9%,11/19)。发病至就诊时间为1 d~1年。在首都医科大学附属北京儿童医院的影像学检查中,16例患儿均首选超声检查,且均诊断出脾扭转合并脾梗死。2例患儿先行计算机断层扫描(computed tomography,CT)检查发现脾脏发育异常情况后,再行超声检查,确诊为脾扭转。14例患儿行脾切除术,3例患儿行保留脾脏手术,2例患儿未手术。17例手术患儿均证实为脾周围韧带发育缺失或不良。除1例死亡病例外,其余18例患儿均恢复顺利。结论脾扭转可以急性或慢性出现,表现为器官轴或网膜轴型扭转。并非所有脾扭转都会继发梗死。脾扭转手术时需根据脾脏血运情况决定手术方式。Objective To explore the clinical characteristics,diagnosis,treatment,and outcomes of splenic torsion in children.Method The clinical data of children diagnosed with splenic torsion(excluding accessory splenic torsion)at Beijing Children's Hospital,Capital Medical University from January 2007 to March 2024 were collected and retrospectively analyzed,including baseline data,clinical manifestation,imaging features,findings in operation,postoperative complications and outcomes of treatment.Result A total of 19 children were included,including 5 males and 14 females.Age ranged from 9 to 168 months,with a median age of 71 months.Abdominal pain(94.7%,18/19)was the most common clinical manifestation,followed by vomiting(57.9%,11/19).The time from onset to treatment was 1 day to 1 year.During the imaging examination at Beijing Children's Hospital,Capital Medical University 16 children were selected for ultrasound examination,and all were diagnosed with splenic torsion combined with splenic infarction.Two children were diagnosed with abnormal splenic development by computed tomography(CT)examination,and then splenic torsion was confirmed by ultrasound examination subsequently.Fourteen children underwent splenectomy,3 children underwent splenic preservation,and 2 children did not undergo surgery.All 17 surgical children were confirmed to have missing or poorly developed ligaments around the spleen.In addition to one death case,the remaining 18 children recovered successfully.Conclusion Splenic torsion can occur acutely or chronically and is characterized by organo-axial or omental-axial torsion.Not all splenic torsion is secondary to infarction.The operation method of splenic torsion should be determined according to the splenic bloodflow.

关 键 词：脾扭转 游走脾 急腹症 儿童 脾切除术 

分 类 号：R720.597[医药卫生—急诊医学]