Criteria for the Selection of Technologies for the Surgical Treatment of Children With Nonparasitic Spleen Cysts

Abstract

In the period from 2000 to 2017, 52 children aged from 2 to 17 years, were operated for non-parasitic spleen cysts. Along with general clinical examination, the preoperative observation included enzyme immunoassay with Echinococcus diagnostics, determination of the serum level of carbohydrate antigen CA19-9, ultrasound, CT scan or MRI, spleen angiography. Evaluation of treatment results, along with clinical examination, was based on echographic monitoring using spleen mass ratio calculation technology and laboratory tests, including the study of serum immunoglobulins A, E, M, G. Depending on the location and pool of vascularization, 4 clinical and morphological variants of spleen cysts were selected - the upper, middle and lower parts of the organ, the region of the spleen's collar. Quantitative estimates of the pathological formation included small (up to 50 ml), medium (50-150 ml), large (150-300 ml) and giant (more than 300 ml) volumes of the cyst cavity. Three main minimally invasive surgical technologies are being introduced:- navigational interventions in which access to the pathological focus and therapeutic effects on the internal structures of the cyst were carried out under the control of an ultrasound image;- combined interventions with access to the pathological focus and therapeutic effect on the internal structures of the cyst under the control of an ultrasound image in combination with endovascular occlusion of the vessels of the spleen parenchyma with X-Ray control;- laparoscopic operations, including access to pathological foci and therapeutic effects on the internal structures of the cyst, provided by the endotelevision visualization. Recovery was achieved in 47 (90.4%) patients as a result of single interventions. Repeated surgeries completed with the recovery were required in 5 (9.6%) clinical observations. Subsequent follow-up with a duration of up to 3 years of disease recurrence did not show relapses. The choice of tactics of surgical treatment of children with NCC was shown to have to be based on the results of multifactorial planning, taking into account the anatomical and topographical features of the localization and growth rate of spleen cysts. The high reparative potential of the spleen in childhood determines the postoperative recovery of the organ’s morphofunctional characteristics, regardless of the volume of the cyst present. The use of quantitative parameters to estimate the mass of the spleen makes it possible to objectify the course of the postoperative period, the effectiveness of the intervention and the adequacy of the reparative regeneration processes.