Детская хирургия. Журнал им. Ю.Ф. Исакова. 2023; 27: 74-81
Лапароскопическая спленэктомия у детей – опыт 25 лет
https://doi.org/10.55308/1560-9510-2023-27-2-74-81Аннотация
Введение. В настоящее время наиболее успешным методом лечения доброкачественных гематологических заболеваний селезёнки у детей является спленэктомия.
Материал и методы. В данной статье представлено описание 25-летнего клинического опыта выполнения лапароскопической спленэктомии у детей с различными заболеваниями селезёнки. Рассматриваются различные подходы к хирургическому лечению заболеваний селезёнки, обсуждаются особенности предоперационной подготовки пациентов, представлены современные данные литературы.
Результаты. Накопленный опыт проведения лапароскопических операций по удалению селезёнки, применение современного электрохирургического оборудования и средств извлечения тканей из брюшной полости позволили существенно сократить время операции, улучшить косметические результаты и качество жизни пациентов в послеоперационном периоде. Использование соматостатина непосредственно до операции и в раннем послеоперационном периоде позволяет избежать у подавляющего числа больных формирования панкреатита и арозивного кровотечения из культи ножки селезёнки.
Заключение. Полученные катамнестические данные позволяют сделать вывод о преимуществе выполнения лапароскопической операции для удаления селезёнки как о безопасном, малотравматичном, эффективном и косметически выгодном варианте хирургического лечения.
Список литературы
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19. Murawski M., Patkowski D., Korlacki W., et al. Laparoscopic splenectomy in children-a multicenter experience. J Pediatr Surg. 2008; 43 (5): 951–4.
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21. Ates U., Tastekin N. Y., Gollu G., Ergun E., Yagmurlu A. Laparoscopic splenectomy in pediatric age: long-term follow-up. Arch Argent Pediatr. 2017 Dec 1; 115 (6): 385–90. doi& 10.5546/aap.2017.eng.e385
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23. Al-Mulhim A. S. Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc. 2012; 26 (11): 3186–9.
24. Al-Meflh W., Karadshah S., Khasawneh G., Qurah A. A., Abddullah B., Al Raymoony A., Al Saidah N., Gayet A. Laparoscopic Splenectomy in Children: Safety of Ligasure Usage. Med Arch. 2020 Apr; 74 (2): 131–3. doi: 10.5455/medarh.2020.74.131-133
25. Englum B. R., Rothman J., Leonard S., et al. Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia. J Pediatr Surg. 2016; 51 (1): 122–7.
26. Tripodi S. I., Shamberger R. C., Heeney M. M., Tubman V. N. Clinical and laboratory outcomes following total or partial splenectomy in patients with hereditary spherocytosis. Pediatr Hematol Oncol. 2019 Sep; 36 (6): 382–9. doi: 10.1080/08880018.2019.1637983
27. Feng S., Qiu Y., Li X., Yang H., Wang C., Yang J., Liu W., Wang A., Yao X., Lai X. H. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis. Pediatric Surgery International. 2016 Mar; 32 (3): 253–9. doi: 10.1007/s00383-015-3845-2
28. Leone G., Pizzigallo E. Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases. Mediterr J Hematol Infect Dis. 2015; 7.
29. Waghorn D. J. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J. Clin. Pathol. 2001; 54: 214–8.
30. Sandra L., Moffett P. C. Overwhelming postsplenectomy infection: Managing patients at risk. J. Am. Acad. Physician Assistants. 2009; 22 (7): 36–40.
31. Spelman D., Buttery J., Daley A., Isaacs D., Jennens I., Kakakios A., et al. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J. 2008; 38: 349–56.
32. Hansen K., Singer D. B. Asplenic hyposplenic overwhelming sepsis: Postsplenectomy sepsis revisited. Ped. Dev. Path. 2001; 4: 105–21.
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34. Uhl W., Anghelacopoulos S. E., Friess H., Büchler M. W. The Role of Octreotide and Somatostatin in Acute and Chronic Pancreatitis. Digestion. 1999; 60 (2): 23–31.
35. Buchler M., Friess H., Klempa I., Hermanek P., Sulkowski U., Becker H., Schafmayer A., Baca I., Lorenz D., Meister R., Kremes B., Wagner P., Witte J., Zurmayer E. L., Jaeger H. D., Rieck B., Dollinger P., Glaser K., Teichmann R., Konradt J., Gauss W., Dennler H. F., Welzel D., Beger H. G. The role of somatostatin analogue octreotide in the prevention of postoperative complications following pancreatic resection. The results of multicenter controlled trial. Am J Surg. 1992; 163: 125–30.
36. Pederzoli P., Bassi C., Falconi M., Camboni M. G. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group. Br J Surg. 1994 Feb; 81 (2): 265–9. doi: 10.1002/bjs.1800810237
37. Deng X.-G., Maharjan A., Tang J., Qiu R.-L., Wu Y.-H., Zhang J., Deng J.-M. A modified laparoscopic splenectomy for massive splenomegaly in children with hematological disorder: a single institute retrospective clinical research. Pediatr Surg Int. 2012 Dec; 28 (12): 1201–9.
38. Zhou J., Wu Z., Cai Y., Wang Y., Peng B. The feasibility and safty of laparoscopic splenectomy for massive splenectomy for massive splenomegaly: a comparative study. J Surg Res. 171 (1): 55–60.
39. Сметанина Н. С., Коновалов Д. М., Клецкая И. С., Щербаков А. П., Талыпов С. Р., Меркулов Н. Н., Варфоломеева С. Р. Ангиома из клеток, выстилающих селезёночный синус. Педиатрия. Журнал им. Г. Н. Сперанского. 2017; 96 (3); 228–33.
40. Толстов К. Н. Лапароскопическая спленэктомия у детей. Автореф. дис. канд. мед. наук. Москва; 2007.
41. Skattum J., Naess P. A., Gaarder C. Non-operative management and immune function after splenic injury. Br J Surg. 2012 Jan; 99(Suppl 1): 59–65. doi: 10.1002/bjs.7764
Russian Journal of Pediatric Surgery. 2023; 27: 74-81
Laparoscopic splenectomy in children – а 25-years of experience
https://doi.org/10.55308/1560-9510-2023-27-2-74-81Abstract
Introduction. Currently, the most successful option for treating benign hematological diseases of the spleen in children is splenectomy.
Material and methods. In the article, the authors present their 25-year clinical experience in performing laparoscopic splenectomy in children with various diseases of the spleen. They discuss different techniques for surgical treatment of spleen diseases, features of preoperative preparation, current literature data.
Results. The accumulated experience in laparoscopic surgeries for spleen removal, application of modern electrosurgical equipment and instruments for extracting tissues from the abdominal cavity have significantly reduced surgical time, improved cosmetic outcomes and quality of life of patients in the postoperative period. Somatostatin, prescribed right before the surgery and at the early postoperative period, prevents development of pancreatitis and erosive bleeding from the stump of the spleen pedicle in the vast majority of patients.
Conclusion. The obtained catamnestic data demonstrate that laparoscopic surgery for spleen removal has its advantages. It is a safe, little-traumatic, effective and cosmetically good option for surgical spleen management in children.
References
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7. Esposito C., Schaarschmidt K., Settimi A., et al. Experience with laparoscopic splenectomy. 2001; 36 (2): 309–11.
8. Utria A. F., Goffredo P., Keck K., Shelton J. S., Shilyansky J., Hassan I. Laparoscopic Splenectomy: Has It Become the Standard Surgical Approach in Pediatric Patients? Journal of surgical research. August 2019; 240: 109–14.
9. A Zhu J., Ye H., Wang Y., et al. Laparoscopic versus open pediatric splenectomy for massive splenomegaly. Surg Innov. 2011; 18 (4): 349–353.
10. Dutta S., Price V. E., Blanchette V., Langer J. C. A laparoscopic approach to partial splenectomy for children with hereditary spherocytosis. Surgical Endoscopy. 2006; 20 (11): 1719–24.
11. Chand B., Walsh R. M., Ponsky J., Brody F. Pancreatic complications following laparoscopic splenectomy. Surg Endosc. 2001; 15: 1273–6.
12. Tsutsumi N., Tomikawa M., Akahoshi T., Kawanaka H., Ota M., 0Sakaguchi Y., et al. Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis: Effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications. Am J Surg. 2016; 212: 882–8.
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20. Montorsi M., Zago M., Mosca F., Capussotti L., Zotti E., Ribotta G., Fegiz G., Fissi S., Roviaro G., Peracchia A., Pivi M., Perego R., Pezzuoli G. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: A prospective, controlled, randomized clinical trial. Surgery. 1995; 117: 26–31.
21. Ates U., Tastekin N. Y., Gollu G., Ergun E., Yagmurlu A. Laparoscopic splenectomy in pediatric age: long-term follow-up. Arch Argent Pediatr. 2017 Dec 1; 115 (6): 385–90. doi& 10.5546/aap.2017.eng.e385
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24. Al-Meflh W., Karadshah S., Khasawneh G., Qurah A. A., Abddullah B., Al Raymoony A., Al Saidah N., Gayet A. Laparoscopic Splenectomy in Children: Safety of Ligasure Usage. Med Arch. 2020 Apr; 74 (2): 131–3. doi: 10.5455/medarh.2020.74.131-133
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26. Tripodi S. I., Shamberger R. C., Heeney M. M., Tubman V. N. Clinical and laboratory outcomes following total or partial splenectomy in patients with hereditary spherocytosis. Pediatr Hematol Oncol. 2019 Sep; 36 (6): 382–9. doi: 10.1080/08880018.2019.1637983
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28. Leone G., Pizzigallo E. Bacterial infections following splenectomy for malignant and nonmalignant hematologic diseases. Mediterr J Hematol Infect Dis. 2015; 7.
29. Waghorn D. J. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J. Clin. Pathol. 2001; 54: 214–8.
30. Sandra L., Moffett P. C. Overwhelming postsplenectomy infection: Managing patients at risk. J. Am. Acad. Physician Assistants. 2009; 22 (7): 36–40.
31. Spelman D., Buttery J., Daley A., Isaacs D., Jennens I., Kakakios A., et al. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J. 2008; 38: 349–56.
32. Hansen K., Singer D. B. Asplenic hyposplenic overwhelming sepsis: Postsplenectomy sepsis revisited. Ped. Dev. Path. 2001; 4: 105–21.
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37. Deng X.-G., Maharjan A., Tang J., Qiu R.-L., Wu Y.-H., Zhang J., Deng J.-M. A modified laparoscopic splenectomy for massive splenomegaly in children with hematological disorder: a single institute retrospective clinical research. Pediatr Surg Int. 2012 Dec; 28 (12): 1201–9.
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