腹腔镜脾血管结扎术治疗儿童遗传性球形红细胞增多症的疗效分析

Efficacy of lapaoscopic splenic arteriovenous ligation for hereditary spherocytosis in children

目的探讨腹腔镜下选择性脾动静脉结扎术治疗儿童遗传性球形红细胞增多症的疗效。方法新疆维吾尔自治区人民医院小儿外科于2014年6月至2016年12月采用腹腔镜下选择性脾动静脉结扎治疗儿童遗传性球形红细胞增多症8例,术中用Hemo-lock结扎脾动脉,选择性结扎脾中下极静脉,保留胃短动脉及脾上极静脉,使脾脏梗死面积达70%以上。结果 8例手术均在腹腔镜下完成,无中转开放手术,手术时间55～90 min,平均时间75 min,术中出血5～15 mL,平均11 mL,住院时间7～10 d,平均住院时间9 d。随访12～24个月,血常规显示红细胞、血小板和白细胞恢复正常; B超提示所有患儿存在脾脏局限性脾梗死。结论腹腔镜下选择性脾动静脉结扎术治疗儿童遗传性球形红细胞增多症操作简单,时间短,创伤小,出血少,可保留脾脏免疫功能,术后治疗效果明显。可作为治疗遗传性球形红细胞增多症脾切除术及选择性脾动脉栓塞术的替代疗法。

Objective To explore the efficacy and feasibility of lapaoscopic selective splenic arteriovenous ligation for hereditary spherocytosis in children.Methods Eight cases of hereditary spherocytosis underwent laparoscopic selective splenic ligation from June 2014 to December 2016.Splenic artery was ligated by using Hem-o-lock,middle and inferior spenic veins were ligated selectively while short gastric artery and superior splenic vein were reserved.Results All laparoscopic procedures were successful without open surgery.The average operative duration was 75(55-90)min,average volume of intraoperative bleeding 11(5-15)mL and average hospitalization time 9(7-10)days.There was no blood transfusion.During a follow-up period of 12-24 months,erythrocytes,platelets and leukocytes were restored to normal.And splenic infraction was detected by ultrasound in all children.Conclusion Laparoscopic selective ligation of splenic artery and vein for pediatric hereditary spherocytosis is simple,time-saving and mini-invasive procedure with minimal bleeding.Capable of preserving splenic immune function with a definite efficacy,it may be used as an alternative therapy for HS splenectomy and selective splenic embolization.