儿童脾切除的认识和体会

THE KNOWLEDE AND EXPERIENCE OF SPLENECTOMY IN CHILDREN

目的探讨有关儿童脾切除术前及术后的相关情况。方法回顾性分析了2001年4月至2004年9月脾切除患儿的资料,共有28例,其中男性16例,年龄最大14岁,最小15月,平均7.8岁,地中海贫血2例、球形红细胞增多症8例、脾肿大3例、ITP10例、脾亢2例、外伤性脾破裂2例、门脉高压症1例,腹腔镜脾切除15例,开腹手术13例,急诊手术2例,择期手术26例。分别比较开腹组与腹腔镜组择期脾切除,通过χ2检验(P<0.05)两者有显著差异。结果所有患者均顺利完成脾切除术,其中20例患者术后有不同程度的血小板计数升高,平均术后一周血小板升高至高峰。3例患儿有轻至中度的激素反应。腹腔镜组术后平均住院5d,天腹组术后平均住院10d。所有患者术后定期口服或肌注广谱抗菌素,随访1月～3年,无近、远期并发症,效期并发症,效果良好。结论儿童脾脏切除需要有一定的手术指征,术前应详细评估,术后应有效监测。腹腔镜下脾切除优点多值得推广。

Objective To discuss details of pre-splenectomy and post-splenectojmy in children. Methos there were 28 patients with splenectomy reviewed and analysis from 2001.4 - 2004.9. which include 16 male, the oldest was 14 years, the youngest was 15 months, average age was 7. 8 years, among the patients, 2 Mediterranean anemia, 8 hemoglobinopathy, 3 spleenmage, 10 ITP, 2 huypersplenism ,2 trumatic spleen repucture, 1 high-port pressure. 15 laparoscopic splenectomy, 13 open-operation, 2 emergency operation. to comparde the laparoscopic group with the opening group and using X^2 （P 〈 0. 05 is statstically significant） Results All patients completed the procedure of the splenectomy,27 patients had a high platelet count after operation. The platelet count climb to the high lever in 7 days post-operation. 3 had mild-moderate hormone reaction, laparoscopy group had 5 days hospitalization, the open-operation group had 10 days hospitaliztion. All patients oral or inject the broad-spectrum antibiotics and follow-up 1 month to 3 years, no complication,which had a nice result. Conclusions the indication of splenectomy in children must be controlled. It should be assessed before operation. These patients must be cared after operation, it was obvious adventage for these patients with laparoscopy splenectomy.