小儿脾疾病临床诊疗指南.docVIP

Guidelines for Surgical Treatment of Pediatric Spleen DiseasesIntroduction The most frequent conditions requiring spleen surgery are hematological and immunological disorders, and trauma. Splenectomy represents the most common splenic procedure, but has potential disadvantages such as postsplenectomy sepsis in 1 in 100 patients. The first report describing laparoscopic splenectomy in children was published in 1993 by Tulman and Holcomb.1 In general, the benefits of the laparoscopic technique are decreased postoperative pain, a shorter duration of postoperative ileus, a lower postoperative morbidity, and a shorter hospitalization.1,2,3 These benefits are also described with laparoscopic therapy of splenic cysts. Definition The normal adult spleen is about 12 cm long and 7 cm wide and weighs 100-200 g. In children, spleens four times larger than normal for age are considered massive. Splenomegaly may be caused by disorders of immunoregulation or splenic blood flow, diseases with abnormal erythrocytes, and infiltrative or infectious diseases. The term hypersplenism (primary or secondary) applies to any clinical situation in which the spleen removes excessive quantities of erythrocytes, granulocytes, or platelets from circulation. Criteria for the diagnosis of hypersplenism include splenomegaly, splenic destruction of one or more cell lines, normal or hyperplastic cellularity of the bone marrow with normal representation of the cell line deficient and, variably, reticulocytosis, circulating immature platelet forms, increased band forms of neutrophils. Splenic cysts are uncommon in children. The diagnosis may be based on gross findings and the presence or abscence of an epithelial lining.5 Hydatid disease of the spleen is often associated with involvement of other organs, especially the liver. Management The importance of preserving the spleen in order to maintain the host’s immunologic response has been widely recognized. Therefore, nonoperative therapy is the f