PDF(Pubmed)
Abstract：
Laparoscopic splenectomy (LS), a treatment for both benign and malignant splenic diseases, can prove technically challenging in patients with massive splenomegaly. In particular, the optimal surgical modality for treating massive splenomegaly in children remains controversial.
The clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression.
The total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378).
For pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.
The clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression.
The total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378).
For pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.
摘要：
背景：腹腔镜脾切除术（LS），良性和恶性脾疾病的治疗方法，在脾肿大患者中可以证明在技术上具有挑战性。特别是,治疗儿童巨大脾肿大的最佳手术方式仍存在争议。
方法：回顾性分析289例因脾肿大而行脾切除术的患儿的临床病理资料。因此，将患者分为LS手术组和开腹脾切除术(OS)手术组.在腹腔镜队列中，根据手术方法将其分为两个亚组：多切口腹腔镜脾切除术（MILS）和单切口腹腔镜脾切除术（SILS）手术组，分别。患者人口统计学，临床资料,手术,并发症,并对术后恢复情况进行分析。同时,我们使用单变量和多变量logistic回归比较了腹腔镜脾切除术不良结局的风险.
结果：与LS组相比，OS组的总手术时间明显缩短（149.87±61.44比188.20±52.51分钟，P<0.001)。相对于操作系统组，LS组术后疼痛评分降低，肠道恢复时间,术后住院时间(P<0.001)。术后并发症和死亡率差异无统计学意义(P>0.05)。然而，SILS手术组的手术时间明显长于MILS手术组（200±46.11比171.39±40.30分钟，P=0.02)。同时,MILS和SILS的手术持续时间与脾长度呈显著正相关。此外，SILS的手术时间与年龄呈显著正相关，体重,和患病儿童的身高。脾长度被证明是不良结局的独立危险因素（P<0.001，OR1.378）。
结论：对于脾肿大的儿科患者，可以耐受长时间的麻醉和手术操作，LS手术证明了最佳治疗方案。SILS仍然是一种新颖的手术疗法，可以被认为是治疗大量脾肿大的替代手术方法。
方法：回顾性分析289例因脾肿大而行脾切除术的患儿的临床病理资料。因此，将患者分为LS手术组和开腹脾切除术(OS)手术组.在腹腔镜队列中，根据手术方法将其分为两个亚组：多切口腹腔镜脾切除术（MILS）和单切口腹腔镜脾切除术（SILS）手术组，分别。患者人口统计学，临床资料,手术,并发症,并对术后恢复情况进行分析。同时,我们使用单变量和多变量logistic回归比较了腹腔镜脾切除术不良结局的风险.
结果：与LS组相比，OS组的总手术时间明显缩短（149.87±61.44比188.20±52.51分钟，P<0.001)。相对于操作系统组，LS组术后疼痛评分降低，肠道恢复时间,术后住院时间(P<0.001)。术后并发症和死亡率差异无统计学意义(P>0.05)。然而，SILS手术组的手术时间明显长于MILS手术组（200±46.11比171.39±40.30分钟，P=0.02)。同时,MILS和SILS的手术持续时间与脾长度呈显著正相关。此外，SILS的手术时间与年龄呈显著正相关，体重,和患病儿童的身高。脾长度被证明是不良结局的独立危险因素（P<0.001，OR1.378）。
结论：对于脾肿大的儿科患者，可以耐受长时间的麻醉和手术操作，LS手术证明了最佳治疗方案。SILS仍然是一种新颖的手术疗法，可以被认为是治疗大量脾肿大的替代手术方法。
