腹腔镜诊治小儿急腹症769例体会

Diagnosis and treatment of acute abdomen by laparoscopy in children：a report of 769 cases

目的探讨腹腔镜在小儿急腹症中应用的价值。方法对我院2005年1月至2011年1月的769例小儿急腹症行腹腔镜探查术病例资料进行回顾分析。结果术前确诊率86．22％（663／769）。术中确诊率99．74％（767／769），2例消化道出血未能确诊，转院继续治疗。完全腹腔镜下进行治疗667例，手术时间25～132（37．3±12．6）min，手术成功率87．26％（671／769）。住院3～10d，平均5d。1例过敏性紫癜、2例大网膜血肿、1例肠系膜血肿术中无需进一步手术处理；5例中转开腹（1例脾破裂、2例消化道出血、1例肠系膜裂孔疝并嵌顿、1例慢性阑尾炎急性发作）；93例腹腔镜辅助切口完成手术。735例随访2～60个月，其中1例未能确诊的消化道出血死亡，另1例未能确诊的消化道出血失访。3例出现脐部线头反应，换药取出线头治愈。余病例无并发症发生。结论腹腔镜确诊率较高，有助于使急腹症患者得到及时、合理、有效的治疗。急诊腹腔镜手术不仅可以对腹部病变及时作出诊断和处理，而且可使一些患者避免不必要的剖腹手术。

Objective To determine the value of laparoscopy for diagnosis and treatment in children with acute abdomen. Methods The clinical data of 769 cases of acute abdomen diagnosed and treated by laparoscope in our department from January 2005 to January 2011 were retrospectively reviewed. Results A total of 767 cases（99.74% ）were surgically diagnosed among which misdiagnoses of 104 cases（13.52% ）were corrected by laparoscopy. Two cases of gastrointestinal hemorrhage could not be definitely diagnosed and were referred to other hospitals. Operation of 667 cases （ 86.74% ） was successfully performed by laparoscopy; Operative duration was 25 - 132 （37.3 ± 12.6）min; Successful rate was 87. 26% （671/769 ） ; Hospital stay was 3 - 10 days （mean 5 days）. Four cases avoided surgery; 93 cases required assisted surgery and 5 cases required laparotomy. A total of 735 cases were followed up for 2 to 60 months, in which one case died and one case was lost. Umbilical thrum rejection occurred in 3 cases and cured after the thrums were removed. No complications occurred in the rest. Conclusions Laparoscopy can provide high rate of diagnosis with prompt, appropriate and effective treatment for patients with acute abdomen. And it can also help some patients to avoid unnecessary laparotomy.