Ashley Wiseman, Alexander Sterlin, Diren Zozan Caliskan, Renos Jeropoulos, Samantha Chippington, Dhanya Mullassery, Kirsty Brennan
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引用次数: 0
Abstract
Background: Non-parasitic splenic cysts (NPSCs) are rare in children, and optimal management remains controversial. We evaluated management and outcomes of paediatric NPSCs through a retrospective cohort study and systematic review.
Methods: All children with NPSCs at two tertiary paediatric centres over 10 years were retrospectively reviewed. Following PRISMA guidelines, a systematic review was also conducted. Outcomes included cyst resolution or recurrence, complications, splenic preservation rates.
Results: 45 patients with NPSCs were analysed in the retrospective cohort: 14 antenatally detected, 18 incidental, 13 symptomatic. Overall, 28/45 (62%) patients were observed, 12/45 (27%) underwent interventional radiology (IR) procedures and 5/45 (11%) surgery. All antenatally detected cysts were observed. Incidentally diagnosed NPSCs requiring further intervention were larger (median 8.2 cm, IQR 7-11; p < 0.001). Symptomatic patients undergoing IR or surgical procedures had no significant difference in median cyst size (13 cm vs 14.2 cm; p = 0.850). IR patients required a median of 3 procedures (IQR 2-4) to reach cyst resolution. Postoperative recurrences were mainly after laparoscopic deroofing (2/3). The systematic review included 31 studies (532 patients). 104 patients (20%) were observed, 53 (10%) underwent IR procedures and 369 (70%) surgery. Symptomatic patients underwent IR or surgical interventions, with subsequent surgery required in 11/53 IR patients (20.7%). Surgical technique varied, with cyst recurrence highest after deroofing (12%) versus 0.7% after partial splenectomy.
Conclusion: Most asymptomatic NPSCs can be observed. For larger, symptomatic NPSCs, IR interventions are feasible but frequently require repetition. Partial splenectomy appears to provide durable spleen-preserving outcomes.
背景：非寄生虫性脾囊肿（NPSCs）在儿童中很少见，其最佳治疗方法仍存在争议。我们通过回顾性队列研究和系统评价来评估儿科npsscs的治疗和结果。方法：回顾性分析了两所三级儿科中心10年以上的所有npsc患儿。根据PRISMA的指导方针，还进行了系统审查。结果包括囊肿消退或复发、并发症、脾保存率。结果：回顾性分析了45例NPSCs患者：14例产前检测，18例偶发，13例有症状。总的来说，28/45（62%）的患者接受了观察，12/45（27%）的患者接受了IR手术，5/45（11%）的患者接受了手术。观察所有产前检测到的囊肿。偶然诊断出需要进一步干预的npsc较大（中位8.2 cm, IQR 7-11; p < 0.001）。有症状的接受IR或外科手术的患者中位囊肿大小无显著差异（13 cm vs 14.2 cm; p=0.850）。IR患者平均需要3次手术（IQR 2-4）才能达到囊肿溶解。术后复发主要发生在腹腔镜下清除后（2/3）。系统评价纳入31项研究（532例患者）。104例患者（20%）接受观察，53例（10%）接受IR手术，369例（70%）接受手术。有症状的患者接受IR或手术干预，11/53 IR患者（20.7%）需要后续手术。手术技术各不相同，切除后的囊肿复发率最高（12%），而部分脾切除术后的囊肿复发率为0.7%。结论：大多数无症状npsc均可观察到。对于较大的有症状的npsc， IR干预是可行的，但通常需要重复。部分脾切除术似乎提供持久的保脾结果。
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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