腹腔镜巨脾切除术治疗小儿遗传性球形红细胞增多症(附7例报告)

Laparoscopic resection of massive splenomegaly for hereditary spherocytosis in children: Report of 7 cases

目的探讨腹腔镜巨脾切除术在小儿遗传性球形红细胞增多症治疗中的可行性及效果评价.方法实施腹腔镜巨脾切除术7例,年龄1～14岁,平均8.8岁;体重10～57 kg,平均33.8kg.其中3例合并胆石症,2例同时行胆囊切除术和1例行胆囊切开取石术.结果手术均获成功,1例脾静脉出血小切口辅助完成.手术时间50～150 min,平均90 min;术中出血量30～500 ml,平均117 ml;住院时间4～10 d,平均5.5 d;术后3 d红细胞计数较术前显著增高(t=2.652,P＜0.05).7例随访2个月～1年,平均7.8月.术前症状完全消失,无明显并发症发生.结论腹腔镜巨脾切除术是治疗小儿遗传性球形红细胞增多症的一种安全有效的方法.

Objective To explore the feasibility and the efficacy of laparoscopic splenectomy of massive splenomegaly in the treatment of hereditary spherocytosis in children. Methods Seven children with massive splenomegaly underwent laparoscopic splenectomy. Their age ranged 1-14 years （mean, 8.8 years）, and their body weight was 10-57 kg （mean, 33.8 kg）. Three children had an accompanying cholelithiasis： 2 of them received a concomitant cholecystectomy and 1 of them, cholecystotomy. Results All the operations were successfully performed under laparoscope, and hand -assisted splenectomy through a small incision was applied in 1 child because of bleeding of the splenic vein. The duration of operation was 50-150 min （ mean, 90 min） , the intraoperative blood loss was 30-500 ml （ mean, 117 ml） , and the length of hospitalization, 4-10 d （ mean, 5.5 d）. The red blood cell counts had significantly increased 3 days following the operation （t=2.652, P〈0.05 ）. On follow-up examinations for 2-12 months, the children were wholly symptom free, without complications. Conclusions Laparoscopic splenectomy of massive splenomegaly is a safe and effective method for the treatment of hereditary spherocytosis in children.