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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。
Objective To investigate the feasibility and effect of splenectomy with a small incision on the left abdominal wall. Methods Thirty-one children undergoing splenectomy were treated with small incision of the lateral abdominal wall. Surgical methods: Take the right lateral decubitus incision to the rectus abdominis edge, posterior edge to the 11th rib tip, cut the skin and abdominal oblique, blunt dissection and open abdominal oblique and transverse abdominal muscle , Into the abdominal cavity after the cut off under the eyes of the spleen ligament, spleen and kidney ligaments and splenopylon ligament, lift the spleen along the direction of its longitudinal pull out the spleen to the incision, the ligation of the cut off the short vascular and splenic blood vessels. Results 31 cases, 22 males and 9 females, with an average age of 9.2 years. Including 25 cases of hereditary spherocytosis, idiopathic thrombocytopenic purpura in 5 cases, 1 case of thalassemia. The splenectomy was performed successfully through this incision. The mean intraoperative blood loss was 10.5ml (5-18ml). The average operation time was 86.4 minutes. The average length of the spleen was 15.5cm and the average width was 11.2cm. The first day after the operation, , The average hospital stay 5.5d (3 ~ 7d). The average follow-up time of 5.3 years (2 to 10 years), no complications, good quality of life. Conclusion The small incision in the left abdominal wall is an ideal approach for the splenic resection of abnormalities of hematological system in children with splenic hypersplenism. The injury is small, and it is easier to handle the ligaments around the spleen and the operation is simple.