兒童腹腔鏡脾切除的初步體會(huì )

【摘要】 　　目的：總結兒童腹腔鏡脾切除的經(jīng)驗和特點(diǎn)。方法：回顧性分析２１例小兒腹腔鏡脾切除患者的臨床資料。結果：順利完成腹腔鏡脾切除術(shù)１８例，中轉開(kāi)腹３例。１例因巨大脾裝入取物袋困難，采用下腹橫切口取出，余均經(jīng)腹壁戳孔在取物袋中夾碎后取出。術(shù)中除１例出血達３００ml外，余均少于１０ml。發(fā)現副脾２例。術(shù)中損傷胃壁１例，術(shù)后出血１例。所有患兒術(shù)后恢復好，平均２d進(jìn)食，住院５～１１d。隨訪(fǎng)１個(gè)月～３年，患者生長(cháng)發(fā)育良好，無(wú)嚴重感染，貧血和血小板計數明顯改善。結論：小兒腹腔鏡脾切除術(shù)具有創(chuàng )傷小、康復快、住院時(shí)間短且腹壁美容的優(yōu)點(diǎn)，是一種安全、有效的術(shù)式。

【關(guān)鍵詞】 脾切除術(shù)　腹腔鏡術(shù)　兒童

　　The primary experience of laparoscopic splenectomy in children

　　【Abstract】 Objective:To summarize the experience of laparoscopic splenectomy in children.Methods:The clinical data of 21 cases of laparoscopic splenectomy in children from Apr.2003 to Dec.2005 was retrospectively analyzed.Results:Eighteen cases were performed successfully,and three cases were converted to open procedure.In laparoscopic splenectomy group,one spleen was taken out through the lower abdominal transverse incision because of megalospleen,other spleens were put into the bag and crushed,then taken out successfully.The blood loss was less than 10ml except 300ml in one case.Two cases were found auxiliary spleen.One case underwent gastric wall repair because of intraoperative damage,and one case complitated postoperative bleeding.All children recovered quickly.They had normal diet two days after operation on average.The hospitalization was ranged from 5 to 11 days.With a follow?up of 1 month to 3 years,all children developed well with no severe infection and anemina.The platelet count increased significantly.Conclusions:Laparoscopic splenectomy is a safe and effective technique because it has such advantages as less trauma,quicker recovery,shorter hospitalization and cosmetic effect of abdominal wall.

　　【Key words】 Splenectomy;Laparoscopy;Children

脾切除在治療某些血液系統疾病中有重要作用。近年，由于腹腔鏡的廣泛應用，腹腔鏡下脾切除(laparoscopic splenectomy,LS）已成為可能。１９９３年Tulman等［１］報告為兒童施行ＬＳ,我國兒童ＬＳ也已有報道［２］。我們?yōu)椋玻崩�患兒施行了Ｌ�?現將體會(huì )報道如下。

　　1 資料與方法

　　1.1 臨床資料

　　本組２１例中男１２例，女９例，１５個(gè)月～１４歲，平均７.８歲。其中，遺傳性球形紅細胞增多癥１１例，特發(fā)性血小板減少性紫癜（idiopathic thrombocytopenia purpura,ＩＴＰ）９例，脾血管瘤伴發(fā)血小板減少１例。

　�。�.２ 手術(shù)方法

　　患兒取全麻平臥或左側抬高位，取臍、中上腹、左上腹３個(gè)５mm切口，放置Trocar，左側腹作１０mm切口置入Trocar，臍部Trocar內放置３０°腹腔鏡，上腹兩個(gè)Trocar為主操作孔，分別放置抓鉗和超聲刀，左腹戳孔置入抓鉗，協(xié)助分離組織。探查腹腔，尋找副脾，如有先切除。用超聲刀離斷大網(wǎng)膜，沿胃大彎游離胃短血管及胃膈韌帶，再至脾下極，分離脾結腸韌帶、脾下極系膜和小血管，于脾蒂后方建立窗口，用腔內切割吻合器將脾蒂釘合切斷，再游離脾腎韌帶，使脾臟完全游離。腹腔內放置取物袋，將脾臟放入袋內，從１０mm切口將取物袋口拖至腹壁外，用腸鉗或卵圓鉗伸入袋內，將脾臟夾碎后取出。檢查脾蒂及分離的創(chuàng )面有無(wú)出血，脾窩放置引流管。

　　2 結 果

　�。保咐�順利完成腹腔鏡下脾切除術(shù)。中轉開(kāi)腹３例，２例為ＩＴＰ，１例為球形紅細胞增多癥。腹腔鏡脾切除１８例

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