儿童脾囊肿的外科治疗策略

Surgical management of splenic cyst in children

目的探讨儿童脾囊肿的诊治情况, 提升临床治疗效果。方法收集2014年1月至2021年1月上海儿童医学中心普外科收治的入院诊断为脾囊肿的14例患儿临床资料。其中, 男10例, 女4例, 年龄为(8.7±3.1)岁, 术前病程时间为(5.1±4.7)个月。术前腹痛8例, 余6例无临床症状。术前均行B型超声和腹部增强CT检查, 其中3例术前行腹部磁共振成像(magnetic resonance imaging, MRI)检查。按术中是否输血, 将患儿分为输血组(5例)和未输血组(9例)。收集患儿的年龄、性别、临床症状、手术前病程时间、术前影像学检查结果、手术方式、手术时间、输血情况、并发症、术后引流管置管时间、病理诊断、术后住院天数、出院后影像学随访结果。结果开放手术4例, 腹腔镜手术10例, 其中2例腹腔镜手术中转开放手术。本研究患儿手术时间为(125.4±52.9) min, 输血组手术时间明显长于未输血组, (176.0±49.2 )min比(97.2±29.1) min, 差异具有统计学意义(P=0.002)。术后病理诊断为假性囊肿4例, 先天性囊肿10例, 10例中表皮样囊肿1例, 皮样囊肿9例, 无并发症。术后引流管置管时间为(5.1±1.7) d, 术后住院时间为(7.9±3.4) d。术后引流管置管时间、术后住院时间在输血组和非输血组之间的差异均无统计学意义(P>0.05)。术后1、3、6个月复查B型超声, 随访时间为(20.8±10.3)个月, 术后复发1例, 病理诊断为皮样囊肿, 再次行腹腔镜手术治疗, 完整切除脾脏。结论对于脾囊肿行保脾手术存在一定的复发率, 需密切随访, 必要时再次手术切除脾脏。

Objective To explore the diagnosis and treatment of splenic cyst in children and boost its clinical efficacy.Methods From January 2014 to January 2021,clinical data were retrospectively reviewed for 14 children of splenic cyst.There were 10 boys and 4 girls with an age range of(8.7±3.1)years and a preoperative disease course of(5.1±4.7)months.Preoperative abdominal pain was present(n=8)and absent(n=6).B-mode ultrasonography and abdominal contrast-enhanced computed tomography(CT)were performed along with abdominal magnetic resonance imaging(MRI,n=3).According to whether or not blood transfusion was performed,they were divided into transfusion group(n=5)and non-transfusion group(n=9).Age,gender,clinical symptoms,preoperative disease course,preoperative imaging studies,surgical approaches,operative duration,blood transfusion,complications,postoperative catheterization time,pathological diagnosis,postoperative hospital stay and imaging follow-up outcomes after discharge were recorded.Results There were open surgery(n=4)and laparoscopy(n=10).And two of the latter were converted into open surgery.Operative duration was(125.4±52.9)min and operative duration was significantly longer in transfusion group than that in non-transfusion group[(176.0±49.2)vs.(97.2±29.1)min]and the difference had statistical significance(P=0.002).Postoperative pathological diagnoses included pseudocyst(n=4),congenital cyst(n=10),epidermoid cyst(n=1)and dermoid cyst(n=9).No surgical complications occurred.The postoperative catheterization time was(5.1±1.7)days and the postoperative hospital stay(7.9±3.4)days.The inter-group differences in postoperative drainage catheterization time or postoperative hospital stay had no statistical significance(P>0.05).B-mode ultrasound was reexamined at 1/3/6 months postoperatively and the follow-up period was(20.8±10.3)months.One child of dermoid cyst had postoperative recurrence and total resection of spleen was performed.Conclusions Recurrence rate remains high for spleen-preserving surgery for splenic cysts.During close follow-ups,reoperation is required for splenic removal.