腹腔镜下脾动脉结扎术治疗小儿脾功能亢进和血小板减少症

Laparoscopic Splenic Artery Ligation in the Treatment of Hypersplenism and Thrombocytopenia in Children

目的探讨腹腔镜下脾动脉结扎术治疗小儿脾功能亢进和血小板减少症中的可行性和有效性。方法 2014年8~12月采用腹腔镜下脾动脉结扎术及部分脾动静脉分支结扎术治疗小儿脾功能亢进和血小板减少症7例,术中将胃结肠韧带用超声刀打开,将胃后壁悬吊于前腹壁;助手将脾脏抬起,暴露胰腺,于胰腺上缘动脉搏动最明显处找到脾动脉,Hem-olok将脾动脉结扎。在脾门处游离脾静脉分支,Hem-o-lok结扎脾静脉分支血管,使脾脏梗死面积达50%以上。结果所有手术均成功完成,无中转开放手术者。手术时间120~150 min,平均126 min;术中出血量为10~20 ml,平均15 ml,无一例输血患儿。术后住院时间4~11 d,平均6.6 d。术后脾脏长径较术前明显减小[(13.6±2.6)cm vs.(15.1±1.7)cm,t=3.199,P=0.049];术后脾脏厚径较术前明显减小[(3.8±1.0)cm vs.(4.1±0.8)cm,t=3.703,P=0.034]。术后B超显示7例患儿存在局灶性脾梗死,脾脏血流减少。术后4例患儿出现高热,体温分别为38.8、39.0、38.6、39.2℃,发热持续时间分别为术后2、4、8、5 d。7例随访6.0~10.0个月,平均8.4月,血常规显示红细胞、血小板和白细胞恢复正常,B超和CT示所有患儿存在局灶性脾梗死和脾脏血流减少。结论腹腔镜下脾动脉结扎术是治疗小儿脾功能亢进和血小板减少症的有效方式。

Objective To investigate the effectiveness and feasibility of laparoscopic splenic artery ligation in the treatment of hypersplenism and thrombocytopenia in children. Methods From August 2014 to December 2014, four children with hypersplenism and three children with ITP (idiopathic thrombocytopenic purpura) were treated in our hospital.Laparoscopic splenic artery ligation was performed in all the patients.During the operation, the gastric colon ligament was cut with an ultrasonic knife, and the gastric wall was suspended to expose the pancreas and the spleen.The splenic artery was ligated at the upper edge of pancreas closing to the splenic hilum.The splenic venous branches were dissected and ligated at the splenic hilum by using the Hem-o-lok, which leaded to an area of splenic infarction more than 50%. Results The laparoscopic splenic artery ligation was successfully performed in all the patients, without conversion to open surgery.The operative time was 120-150 min ( mean, 126 min) , and the intraoperative blood loss was 10-20 ml ( mean, 15 ml) .No patient underwent blood transfusion.The length of postoperative hospital stay varied from 4 to 11 days (mean, 6.6 days).The splenic length significantly decreased postoperatively [(13.6 ±2.6) cm vs.(15.1 ±1.7) cm, t=3.199, P=0.049], and so was the splenic thickness [(3.8 ±1.0) cm vs.(4.1 ±0.8) cm, t =3.703, P=0.034].Partial splenic infarction and decreased splenic blood flow were found in the 7 patients by postoperative ultrasound.After surgery, four children suffered from fever, which were 38.8 ℃, 39.0 ℃, 38.6 ℃, and 39.2 ℃, with the duration of fever of 2, 4, 8, and 5 days, respectively.All the patients were followed-up for 6 -10 months (mean, 8.4 months).The complete blood cell count was within normal range. Conclusion The laparoscopic splenic artery ligation is an effective treatment for hypersplenism and thrombocytopenia in children.