CAJ | 학술논문

目的探讨应用腹腔镜脾切除术(laparoscopic splenectomy,LS)和开腹脾切除术(open splenectomy,OS)治疗儿童血液病的临床疗效.方法回顾2003年1月至2013年11月行脾切除治疗儿童血液病73例的临床资料.按手术方法不同,将其中35例腹腔镜脾切除术(LS组)与38例开腹脾切除术(OS组)进行对比分析.两组术后随访1个月～10年.结果 LS组与OS组均完成手术.LS组有33例患儿成功实施脾切除术,2例小切口辅助中转开腹手术.LS组和OS组平均手术时间分别为(126±38)min和(100±45) min,术中平均出血量为(36.7±20.6)ml和(33.2±16.8)ml,术后平均恢复饮食的时间约为1.5d和2.5d,副脾发现率分别为42.8％(15/35)和31.5％(12/38).两组比较,平均手术时间和术后恢复饮食的时间差异均有统计学意义(P＜0.05).LS组术后并发症发生率为8.6％(3/35),OS组为13.2％(5/38).LS组治疗血液病长期疗效和OS组相似.结论 ①小儿腹腔镜脾切除术切实可行、安全有效,LS可替代OS成为治疗儿童良性血液病的措施.②LS与OS相比具有副脾发现率高、创伤小、术后恢复快、并发症少、伤口小而美观等优点.
목적 탐토응용복강경비절제술(laparoscopic splenectomy,LS)화개복비절제술(open splenectomy,OS)치료인동혈액병적림상료효.방법 회고2003년1월지2013년11월행비절제치료인동혈액병73례적림상자료.안수술방법불동,장기중35례복강경비절제술(LS조)여38례개복비절제술(OS조)진행대비분석.량조술후수방1개월～10년.결과 LS조여OS조균완성수술.LS조유33례환인성공실시비절제술,2례소절구보조중전개복수술.LS조화OS조평균수술시간분별위(126±38)min화(100±45) min,술중평균출혈량위(36.7±20.6)ml화(33.2±16.8)ml,술후평균회복음식적시간약위1.5d화2.5d,부비발현솔분별위42.8％(15/35)화31.5％(12/38).량조비교,평균수술시간화술후회복음식적시간차이균유통계학의의(P＜0.05).LS조술후병발증발생솔위8.6％(3/35),OS조위13.2％(5/38).LS조치료혈액병장기료효화OS조상사.결론 ①소인복강경비절제술절실가행、안전유효,LS가체대OS성위치료인동량성혈액병적조시.②LS여OS상비구유부비발현솔고、창상소、술후회복쾌、병발증소、상구소이미관등우점.
Objective To compare laparoscopic splenectomy (LS) versus open splenectomy (OS) for the treatment of hematologic diseases in children.Methods Retrospective reviews were conducted for the clinical records of 73 children undergoing splenectomy for hematologic diseases at our institution during January 2003 to November 2013.According to different operative approaches,LS (n =35) and OS (n =38) were assigned and compared.The follow-up period was 1 month to 10 years.Results Both groups underwent splenectomy.A total of 33 total LS were performed successfully.Conversion was performed with small incision in 2 patients.The average operative duration was (126 ± 38) min for LS versus (100 ± 45) min for OS (P＜0.05) ; average intraoperative blood loss (36.7 ± 20.6) ml for LS versus (33.2 ± 16.8) ml for OS (P＞0.05).Time to resumption of oral intake averaged 1.5 days for LS and 2.5 days for OS (P＜0.05).The incidence of accessory spleens was 42.8％ for LS and 31.5％ for OS.The postoperative complications were 8.6％ for LS and 13.2％ for OS respectively.The long-term efficacies of LS and OS were similar in the management of hematologic diseases.Conclusions LS is feasible,efficacious and safe for hematological diseases in children.It offers many advantages of mini-invasiveness,quick recovery,fewer postoperative complications and a higher discovery rate of accessory spleens over OS.