儿童腹腔镜脾切除的初步体会

【摘要】　　目的.：总结儿童腹腔镜脾切除的经验和特点。方法：回顾性分析２１例小儿腹腔镜脾切除患者的临床资料。结果：顺利完成腹腔镜脾切除术１８例，中转开腹３例。１例因巨大脾装入取物袋困难，采用下腹横切口取出，余均经腹壁戳孔在取物袋中夹碎后取出。术中除１例出血达３００ml外，余均少于１０ml。发现副脾２例。术中损伤胃壁１例，术后出血１例。所有患儿术后恢复好，平均２d进食，住院５～１１d。随访１个月～３年，患者生长发育良好，无严重感染，贫血和血小板计数明显改善。结论：小儿腹腔镜脾切除术具有创伤小、康复快、住院时间短且腹壁美容的优点，是一种安全、有效的术式。

【关键词】脾切除术　腹腔镜术　儿童

The primary experience of laparoscopic splenectomy in children

　　【Abstract】 Objective:To summarize the experience of laparoscopic splenectomy in ods:The clinical data of 21 cases of laparoscopic splenectomy in children from Apr.2003 to Dec.2005 was retrospectively lts:Eighteen cases were performed successfully,and three cases were converted to open 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 blood loss was less than 10ml except 300ml in one cases were found auxiliary case underwent gastric wall repair because of intraoperative damage,and one case complitated postoperative children recovered had normal diet two days after operation on hospitalization was ranged from 5 to 11 a follow?up of 1 month to 3 years,all children developed well with no severe infection and platelet count increased lusions: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

脾切除在治疗某些血液系统疾病中有重要作用。近年，由于腹腔镜的广泛应用，腹腔镜下脾切除(laparoscopic splenectomy,LS）已成为可能。１９９３年Tulman等［１］报告为儿童施行ＬＳ,我国儿童ＬＳ也已有报道［２］。我们为２１例患儿施行了ＬＳ,现将体会报道如下。

1 资料与方法

1.1 临床资料

本组２１例中男１２例，女９例，１５个月～１４岁，平均７.８岁。其中，遗传性球形红细胞增多症１１例，特发性血小板减少性紫癜（idiopathic thrombocytopenia purpura,ＩＴＰ）９例，脾血管瘤伴发血小板减少１例。

１.２手术方法

患儿取全麻平卧或左侧抬高位，取脐、中上腹、左上腹３个５mm切口，放置Trocar，左侧腹作１０mm切口置入Trocar，脐部Trocar内放置３０°腹腔镜，上腹两个Trocar为主操作孔，分别放置抓钳和超声刀，左腹戳孔置入抓钳，协助分离组织。探查腹腔，寻找副脾，如有先切除。用超声刀离断大网膜，沿胃大弯游离胃短血管及胃膈韧带，再至脾下极，分离脾结肠韧带、脾下极系膜和小血管，于脾蒂后方建立窗口，用腔内切割吻合器将脾蒂钉合切断，再游离脾肾韧带，使脾脏完全游离。腹腔内放置取物袋，将脾脏放入袋内，从１０mm切口将取物袋口拖至腹壁外，用肠钳或卵圆钳伸入袋内，将脾脏夹碎后取出。检查脾蒂及分离的创面有无出血，脾窝放置引流管。