脐部双切口悬吊腹腔镜小儿阑尾切除术的临床应用

Clinical application of double umbilical ports and suspension method in laparoscopic appendectomy

目的探讨脐部双切口悬吊在腹腔镜小儿阑尾切除术中应用的可行性。方法 2010年4月～2011年1月,对27例确诊为急性单纯性、化脓性和慢性阑尾炎患儿行脐部双切口悬吊腹腔镜阑尾切除、包埋术。术中脐环两侧各一个5mm切口,插入外径5.5mm Trocar。镜下沿结肠带向盲肠顶端找到阑尾,从右下腹壁将20带针丝线刺入腹腔,丝线尾部留在腹腔外,便于后面打结及牵引。于阑尾根部近结肠侧(在距盲肠0.5cm处)缝合阑尾根部浆肌,利用操作钳与尾部留在腹腔外的丝线打结并牵引,将阑尾提起显露系膜,带针20丝线缝扎阑尾,用超声刀紧贴阑尾切断系膜,再于结扎线远侧0.5cm处切断阑尾,阑尾残端用超声刀电灼。另外从腹壁穿入40带针丝线荷包缝合包埋阑尾残端。结果手术时间20～45(28.6±10.5)min,术后排气时间4～12(10±4.5)h,术后住院时间4～5d。术后切口全部一期愈合,无近期并发症。随访1～8个月,切口愈合良好,未见明显瘢痕,脐部外形好。结论脐部双切口悬吊腹腔镜小儿阑尾切除术中借助从腹壁传入的丝线可以做到阑尾根部缝扎和荷包包埋,是安全、有效、可行的阑尾切除方法之一,达到了脐部单孔腹腔镜阑尾切除术的美容效果。

Objective To discuss the feasibility of double umbilical ports and suspension in laparoscopic appendectomy.Methods 27 patients with appendicitis were performed LA with double umbilical ports and suspension method.Laparoscope and operating forceps were separately introduced into abdominal cavity through the double umbilical ports.After the appendix was identified,the root was suspended with a piece of fine copper wire and embedded with the other wire,and then the appendectomy was performed.Results All of 27 patients were successfully performed LA.The average operative time was 28.6 min （range 20～45 min）.There were no operative complications.The most postoperative hospital stays were 4～5 days.Conclusions The laparoscopic appendectomy with double umbilical ports and suspension method is a feasible,effective and safe technique.It expands the indications with one trocar laparoscopic appendectomy and has a good cosmetic effect.