侧腹壁小切口小儿脾切除术的应用研究

目的探讨左侧腹壁小切口行脾切除的可行性和效果。方法对31例需行脾切除的患儿采取侧腹壁小切口手术。手术方法:取右侧卧位,切口前缘至腹直肌鞘外缘,后缘至第11肋尖,切开皮肤和腹外斜肌,钝性分离拉开腹内斜肌和腹横肌,进入腹腔后于直视下切断脾结肠韧带、脾肾韧带及脾隔韧带,提起脾下极沿其纵轴方向牵拉托出脾脏至切口外,结扎切断胃短血管和脾蒂血管。结果31例中,男22例,女9例,平均年龄9.2岁。其中遗传性球形红细胞增多症25例,特发血小板减少性紫癜5例,地中海贫血1例。均经此切口成功切除脾脏,术中平均出血10.5ml(5~18ml),平均手术时间86.4min,切除脾脏平均长度15.5cm,平均宽度11.2cm,术后第1天开始进食流质,均康复出院,平均住院时间5.5d(3~7d)。平均随访时间5.3年(2~10年),无并发症发生,生存质量良好。结论左侧腹壁小切口是小儿血液系统异常疾病合并脾功能亢进脾切除的理想入路,损伤小,处理脾周围韧带较为容易,操作简单。

Splenectomy using lateral abdominal wall approach with small incision in Children

Objective To evaluate the feasibility and effectiveness of splenectomy (OS) through a left lateral approach in children. Methods Thirty-one consecutive open splenectomies by lateral approach performed between 1995 and 2006 were reviewed. The series included 22 boys and 9 girls with an average age of 9.2 years. Indications included hereditary spherocytosis (n = 25), immune thrombocytopenic purpura (n = 5), and sickle cell anemia (n = 1). The operation was performed with the child in the right lateral decubitus position through a left upper abdominal incision .First anterior edge of incision reaching to external edge of rectus abdominis sheath.Posterior edge to the 18th costae tip,incised the skin and obliqaus externus abdominis,the obliguas internas abdominis and transverse musele of abdomen was separated dully,then cut off the Colic,Lienorenal- and Lienophrenic Ligaments under open vision after it enter into abdominal carity,along longitudinal direction elevated the low pole of spleen,the spleen was pull-through to out of incision,ligating the stomach short blood vessel and splenic pedicle. Results All 31 cases were completed without intraoperative complications with an average surgical time of 86.4 minutes (range, 52 to 125). The average surgical blood loss was 10.5 mL (range, 5 to 18). The children started feeding at the first day postoperatively. There was no mortality or morbidity. Conclusions Lateral splenectomy is performed with shorter surgical times, less blood loss, an excellent cosmetic outcome, without complications.