腹腔镜在18例小儿急性结肠穿孔中的应用分析

Laparoscopy in 18 Cases of Pediatric Acute Colonic Perforation Analysis Application

目的:对腹腔镜在小儿急性结肠穿孔中的应用进行评价分析。方法:回顾性分析18例急性结肠穿孔患儿的资料,分为开放手术组和腹腔镜手术组,对两组患儿年龄、体重、C反映蛋白、穿孔数目、手术时间、手术并发症进行描述并比较分析。结果:两组患儿年龄、体重、C反映蛋白、穿孔数目、手术时间、住院时间比较差异无统计学意义(P>0.05),腹腔镜手术组中1例吻合口瘘,1例尿路感染,而开放手术组伤口感染、肠粘连的发生率高于腹腔镜手术组,差异有统计学意义(P<0.05)。结论:腹腔镜在小儿急性结肠穿孔治疗中的应用是可行安全的。

Objective ：The aim of the present study was to evaluate the feasibility of laparoscopic colectomy for children in emergent settings. Method ：From 2006 January to 2011 October, 9 consecutive children with acute colonic perforations and fibropurulent peritonitis secondary to infectious colitis underwent emergency laparoscopic colectomy. Simultaneously, we reviewed and recorded the same data from another consecutive 9 patients who underwent standard laparotomy .The two groups were compared with regard to operative time, length of hospital stay （LOS）, and complications. Result ：The gender, age, body weight, serum C-reactive protein, number of involved bowel segments, operative time, and LOS of two group were not significantly different（P〉0.05）. In the laparoscopy group, one patient required conversion to open surgery because of extensive bowel involvement, and another patient with solitary colonic perforation required reoperation for anastomostic leakage. However, patients who underwent laparotomy had a higher incidence of later complications, including wound infection, incisional hernia, and adhesion ileus and thus required more additional unplanned operations. Conclusion ：Emergency laparoscopic surgery is technically feasible in most children with acute colonic perforations and fibropurulent peritonitis. However, extensive intestinal involvement with multiple perforations should be an indication for converting to open surgery.