CAJ | 학술논문

目的总结儿童经脐单切口腹腔镜脾切除术的初步经验,并探讨其可行性和安全性.方法回顾分析2010年4月至2011年1月期间5例脾相关疾病儿童经脐单切口入路腹腔镜脾切除术的临床资料,男3例,女2例,年龄4～12岁,包括遗传性球形红细胞增多症3例和特发性血小板减少性紫癜2例.我们使用自行改进的三通道套管和弯曲器械,超声刀切断脾周围韧带,切割钉合器或生物夹处理脾蒂,脾脏从单切口取出.结果 5例腹腔镜脾切除术均经脐单切口入路获得成功,没有中转常规腹腔镜手术.手术时间125～220 min,估计术中出血量10～30 ml,无围手术期并发症,术后5～8 d痊愈出院.随访3～12个月,5例患儿均生长发育良好,贫血得到纠正,血小板计数正常.结论经脐单切口腹腔镜脾切除术较常规腹腔镜脾切除术对腹壁创伤更小、美容效果更好,可在儿童安全实施;但需要更多数量和进一步前瞻性研究来评价其真正益处.
목적 총결인동경제단절구복강경비절제술적초보경험,병탐토기가행성화안전성.방법 회고분석2010년4월지2011년1월기간5례비상관질병인동경제단절구입로복강경비절제술적림상자료,남3례,녀2례,년령4～12세,포괄유전성구형홍세포증다증3례화특발성혈소판감소성자전2례.아문사용자행개진적삼통도투관화만곡기계,초성도절단비주위인대,절할정합기혹생물협처리비체,비장종단절구취출.결과 5례복강경비절제술균경제단절구입로획득성공,몰유중전상규복강경수술.수술시간125～220 min,고계술중출혈량10～30 ml,무위수술기병발증,술후5～8 d전유출원.수방3～12개월,5례환인균생장발육량호,빈혈득도규정,혈소판계수정상.결론 경제단절구복강경비절제술교상규복강경비절제술대복벽창상경소、미용효과경호,가재인동안전실시;단수요경다수량화진일보전첨성연구래평개기진정익처.
Objective To review our initial experience of transumbilical single incision laparoscopic splenectomy in children and to assess the feasibility and safety of this laparoscopic procedures.Methods Clinical data of 5 children who underwent laparoscopic splenectomy via a single umbilical incision between April 2010 and January 2011 were reviewed. There were 3 boys and 2 girls. The age ranged from 4 to 12 years. Of them,3 cases suffered from hereditary spherocytosis and 2 cases from idiopathic thrombocytopenic purpura. We used the Tri-port and self-modified curved instruments. The splenic attachments were taken down using the harmonic scalpel,and the hilum was clipped with Hemo-lok or transected with Endo-GIA. The spleen was removed from the abdomen via the single incision.Results All of the laparoscopic splenectomies were completed successfully with transumbilical single incision approach without conversion to conventional laparoscopic surgery. The operation time ranged from 125 to 220 min and the estimated blood loss was 10-30ml. There were no perioperative complications. All patients recovered that the postoperative hospital stay was 5-8 days. During a follow-up period of 3 to 12 months,all children were very well with improved growth and normal hemotology. Conclusions Compared with standard laparoscopic splenectomy, transumbilical single incision laparoscopic splenectomy may reduce surgical trauma,and improve cosmesis. A large prospective trial will be necessary to assess the true benefit of this approach.