腹腔镜脾血管结扎术治疗儿童遗传性球形红细胞增多症的疗效分析
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摘要
目的探讨腹腔镜下选择性脾动静脉结扎术治疗儿童遗传性球形红细胞增多症的疗效。方法新疆维吾尔自治区人民医院小儿外科于2014年6月至2016年12月采用腹腔镜下选择性脾动静脉结扎治疗儿童遗传性球形红细胞增多症8例,术中用Hemo-lock结扎脾动脉,选择性结扎脾中下极静脉,保留胃短动脉及脾上极静脉,使脾脏梗死面积达70%以上。结果 8例手术均在腹腔镜下完成,无中转开放手术,手术时间55～90 min,平均时间75 min,术中出血5～15 mL,平均11 mL,住院时间7～10 d,平均住院时间9 d。随访12～24个月,血常规显示红细胞、血小板和白细胞恢复正常; B超提示所有患儿存在脾脏局限性脾梗死。结论腹腔镜下选择性脾动静脉结扎术治疗儿童遗传性球形红细胞增多症操作简单,时间短,创伤小,出血少,可保留脾脏免疫功能,术后治疗效果明显。可作为治疗遗传性球形红细胞增多症脾切除术及选择性脾动脉栓塞术的替代疗法。
Objective To explore the efficacy and feasibility of lapaoscopic selective splenic arteriovenous ligation for hereditary spherocytosis in children. Methods Eight cases of hereditary spherocytosis underwent laparoscopic selective splenic ligation from June 2014 to December 2016. Splenic artery was ligated by using Hem-o-lock,middle and inferior spenic veins were ligated selectively while short gastric artery and superior splenic vein were reserved. Results All laparoscopic procedures were successful without open surgery. The average operative duration was 75( 55-90) min,average volume of intraoperative bleeding 11( 5-15) mL and average hospitalization time 9( 7-10) days. There was no blood transfusion. During a follow-up period of 12-24 months,erythrocytes,platelets and leukocytes were restored to normal. And splenic infraction was detected by ultrasound in all children. Conclusion Laparoscopic selective ligation of splenic artery and vein for pediatric hereditary spherocytosis is simple,time-saving and mini-invasive procedure with minimal bleeding. Capable of preserving splenic immune function with a definite efficacy,it may be used as an alternative therapy for HS splenectomy and selective splenic embolization.
Objective To explore the efficacy and feasibility of lapaoscopic selective splenic arteriovenous ligation for hereditary spherocytosis in children. Methods Eight cases of hereditary spherocytosis underwent laparoscopic selective splenic ligation from June 2014 to December 2016. Splenic artery was ligated by using Hem-o-lock,middle and inferior spenic veins were ligated selectively while short gastric artery and superior splenic vein were reserved. Results All laparoscopic procedures were successful without open surgery. The average operative duration was 75( 55-90) min,average volume of intraoperative bleeding 11( 5-15) mL and average hospitalization time 9( 7-10) days. There was no blood transfusion. During a follow-up period of 12-24 months,erythrocytes,platelets and leukocytes were restored to normal. And splenic infraction was detected by ultrasound in all children. Conclusion Laparoscopic selective ligation of splenic artery and vein for pediatric hereditary spherocytosis is simple,time-saving and mini-invasive procedure with minimal bleeding. Capable of preserving splenic immune function with a definite efficacy,it may be used as an alternative therapy for HS splenectomy and selective splenic embolization.
引文
1 Alzen G,Basedow J,Luedemann M,et al.Partial splenic embolization as an alternative to splenectony in hypersplenism.single center experience in 16 years[J].Klin Paliatr,2010,222(6):368-373.DOI:10.1055/s-0030-1263183.
2 Huang JH,Gao F,Gu YK,et al.Combined treatment of hepatocellular carrinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization[J].Word JGastroenterol,2007,13(48):6593-6597.DOI:10.3748/wjg.13.6593.
3 Di Sabatino A,Carsetti R,Corazza CR.Post-splenectomy and hyposplenic states[J].Lancet,2011,378(9785):86-97.DOI:10.1016/S0140-6736(10)61493-6.
4 Cheng Z,Yu F,Tian J,et al.A comparative study of two anticoagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization[J].JThromb Thrombolysis,2015,40(3):294-301.DOI:10.1007/s11239-015-1190-x.
5 Hassn AM,Al-Fallouji MA,Ouf TI,et al.Portal vein thrombosis following splenecttomy[J].Br J Surg,2000,87(3):362-373.DOI:10.1016/S0002-9610(02)01095-4.
6 Tracy ET,Haas KM,Gentry T,et al.Partial splenectomy but not total splenectomy preserves immunoglobulin M memory Bcells in mice[J].J Pediatr Surg,2011,46(9):1706-1710.DOI:10.1016/j.jpedsurg.2011.04.020.
7 Boyer TD,Habib S.Big spleens and hepersplenism:fix it or forget it?[J].Liver Int,2015,35(5):1492-1498.DOI:10.1111/liv.12702.
8胡三元,陈波,王可新,等.术前脾动脉栓塞对腹腔镜巨脾切除术影响的动物实验研究[J].腹腔镜外科杂志,2005,10(5):274-276.DOI:10.13499/j.issn.1009-6612.Hu SY,Chen B,Wang KX,et al.The experimental study of splenic embolization before laparoscopic megasplenectomy[J].Journal of Laparoscopic Surgery,2005,10(5):274-276.DOI:10.13499/j.issn.1009-6612.
9王彦丽,吕鑫.部分脾栓塞术治疗遗传性球形红细胞增多症远期疗效观察[J].介入放射学杂志,2013,10(22):807-809.DOI:10.3969/j.issn.1008-794X.2013.10.005.Wang YL,Lv X.Partial splenic embolization for the treatment of hereditary spherocytosis:its long-term efficacy[J].JIntervent Radiol,2013,10(22):807-809.DOI:10.3969/j.issn.1008-794X.2013.10.005.
10 Haened RK,Thompson HR,Kumpe DA,et al.Partial splenic embolizationin 5 children with hypersplenism:effects of reduced-volume embolization efficacy and morbidity[J].Radiology,1998,209(3):803-806.DOI:10.1148/radiology.209.3.9844678.
11 Dionigi R,Boni L,Rausei S,et al.History of splenectomy[J].Int J Surg,2013,11(Suppl 1):S42-S43.DOI:10.1016/S1743-9191(13)60013-8.
12 Liu DL,Xia S,Xu W,el al.Anatomy of vasculature of 850spleen specimens and its application in partial splenectomy[J].Surgery,1996,119(1):27-33.DOI:10.1016/s0039-6060(96)80209-1.
13 Redmond HP,Redmond JM,Rooney BP,el al.Surgical anatomy of the human spleen[J].Br J Surg,1989,76(2):198-201.
14邹丽莉,程永亮.脾功能亢进伴发恶性淋巴瘤脾动脉栓塞化疗一例[J].介入放射学杂志,2006,9(15):520.DOI:10.3969/j.issn.1008-794X.2006.09.021.Zou LL,Cheng YL.Splenic arterial chemo-embolization in treating hyper-splenia concomitant with malignant lymphoma:Case report[J].J Intervent Radiol,2006,9(15):520.DOI:10.3969/j.issn.1008-794X.2006.09.0 21.
15张金山,李龙.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[J].中国微创外科杂志,2015,12(15):1075-1079.DOI:10.3969/j.issn.1009-6604.2015.12.006.Zhang JS,Li L.Laparoscopic splenic artery ligation for hypersplenism and thrombocytopenia in children[J].Chin JMIN Inv Surg,2015,12(15):1075-1079.DOI:10.3969/j.issn.1009-6604.2015.12.006.
2 Huang JH,Gao F,Gu YK,et al.Combined treatment of hepatocellular carrinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization[J].Word JGastroenterol,2007,13(48):6593-6597.DOI:10.3748/wjg.13.6593.
3 Di Sabatino A,Carsetti R,Corazza CR.Post-splenectomy and hyposplenic states[J].Lancet,2011,378(9785):86-97.DOI:10.1016/S0140-6736(10)61493-6.
4 Cheng Z,Yu F,Tian J,et al.A comparative study of two anticoagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization[J].JThromb Thrombolysis,2015,40(3):294-301.DOI:10.1007/s11239-015-1190-x.
5 Hassn AM,Al-Fallouji MA,Ouf TI,et al.Portal vein thrombosis following splenecttomy[J].Br J Surg,2000,87(3):362-373.DOI:10.1016/S0002-9610(02)01095-4.
6 Tracy ET,Haas KM,Gentry T,et al.Partial splenectomy but not total splenectomy preserves immunoglobulin M memory Bcells in mice[J].J Pediatr Surg,2011,46(9):1706-1710.DOI:10.1016/j.jpedsurg.2011.04.020.
7 Boyer TD,Habib S.Big spleens and hepersplenism:fix it or forget it?[J].Liver Int,2015,35(5):1492-1498.DOI:10.1111/liv.12702.
8胡三元,陈波,王可新,等.术前脾动脉栓塞对腹腔镜巨脾切除术影响的动物实验研究[J].腹腔镜外科杂志,2005,10(5):274-276.DOI:10.13499/j.issn.1009-6612.Hu SY,Chen B,Wang KX,et al.The experimental study of splenic embolization before laparoscopic megasplenectomy[J].Journal of Laparoscopic Surgery,2005,10(5):274-276.DOI:10.13499/j.issn.1009-6612.
9王彦丽,吕鑫.部分脾栓塞术治疗遗传性球形红细胞增多症远期疗效观察[J].介入放射学杂志,2013,10(22):807-809.DOI:10.3969/j.issn.1008-794X.2013.10.005.Wang YL,Lv X.Partial splenic embolization for the treatment of hereditary spherocytosis:its long-term efficacy[J].JIntervent Radiol,2013,10(22):807-809.DOI:10.3969/j.issn.1008-794X.2013.10.005.
10 Haened RK,Thompson HR,Kumpe DA,et al.Partial splenic embolizationin 5 children with hypersplenism:effects of reduced-volume embolization efficacy and morbidity[J].Radiology,1998,209(3):803-806.DOI:10.1148/radiology.209.3.9844678.
11 Dionigi R,Boni L,Rausei S,et al.History of splenectomy[J].Int J Surg,2013,11(Suppl 1):S42-S43.DOI:10.1016/S1743-9191(13)60013-8.
12 Liu DL,Xia S,Xu W,el al.Anatomy of vasculature of 850spleen specimens and its application in partial splenectomy[J].Surgery,1996,119(1):27-33.DOI:10.1016/s0039-6060(96)80209-1.
13 Redmond HP,Redmond JM,Rooney BP,el al.Surgical anatomy of the human spleen[J].Br J Surg,1989,76(2):198-201.
14邹丽莉,程永亮.脾功能亢进伴发恶性淋巴瘤脾动脉栓塞化疗一例[J].介入放射学杂志,2006,9(15):520.DOI:10.3969/j.issn.1008-794X.2006.09.021.Zou LL,Cheng YL.Splenic arterial chemo-embolization in treating hyper-splenia concomitant with malignant lymphoma:Case report[J].J Intervent Radiol,2006,9(15):520.DOI:10.3969/j.issn.1008-794X.2006.09.0 21.
15张金山,李龙.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[J].中国微创外科杂志,2015,12(15):1075-1079.DOI:10.3969/j.issn.1009-6604.2015.12.006.Zhang JS,Li L.Laparoscopic splenic artery ligation for hypersplenism and thrombocytopenia in children[J].Chin JMIN Inv Surg,2015,12(15):1075-1079.DOI:10.3969/j.issn.1009-6604.2015.12.006.