经脐单切口腹腔镜技术在小儿胰腺肿瘤切除术中的应用

Single-incision laparoscopic surgery in children with pancreatic tumor

目的探讨经脐单切口腹腔镜技术在小儿胰腺肿瘤切除手术中的效果和可行性。方法2011年7月至2013年8月，3例患儿因胰腺病变就诊我院，其中1例为局灶性胰岛细胞增生症，1例为弥漫性胰岛细胞增生症，1例为先天性胰母细胞瘤。所有患儿均接受经脐单切口腹腔镜手术治疗。术后对所有患儿进行跟踪随访，内容包括术后低血糖症状缓解与否，定期复查血胰岛素、血糖浓度、腹部B超等。7例应用传统腹腔镜技术进行胰腺肿瘤切除术的患儿作为对照组。结果手术时间120～200min（平均153．3min），较对照组（170～215min，平均187min）低。术中出血量较少，无输血者。术后腹腔引流时间为3～4d（平均3．3d），较对照组（2～7d，平均5．8d）低。术后住院时间为6～7d（平均6．3d），较对照组（3～24d，平均16d）明显较低。2例高胰岛素血症性低血糖患儿术后空腹血糖浓度较术前升高，术后空腹血胰岛素浓度较术前降低。所有患儿术后无胰瘘、胰腺出血等并发症。迄今为止随访4～29个月，所有患儿血糖浓度和血胰岛素浓度恢复正常，定期复查B超未出现复发者。结论经脐单切口腹腔镜技术在胰腺肿瘤切除术中应用效果满意，值得应用。

Objective To explore the outcomes of single-incision laparoscopic surgery（SILS）for pancreatic tumor in children. Methods Between July 2011 and August 2013, SILS was performed in 3 children with pancreatic diseases. One with persistent hyperinsulinemic hypoglycemia of infancy （PHHI） underwent partial pancreatectomy and the histologic diagnosis was focal nesidioblastosis. Another with PHHI had 90% pancreatectomy with a histologic diagnosis of diffuse nesidioblastosis. And one with pancreatic cyst underwent pancreatic cystectomy with a histologic diagnosis of congenital pancreatoblastoma. All patients were followed up. Seven children undergoing conventional laparoscopic pancreatectomy were selected as the control group. Results The mean time required for surgery was 153.3 （120-200） min and it was lower than that of the controls 187 （170-215） rain. Blood loss was minimal without necessity for blood transfusion. The mean duration of postoperative abdominal drainage was 3. 3 （3-4） days and it was lower than that of the controls 5.8 （2-7） days. The mean postoperative hospitalization period was 6. 3 （6-7） days and it was lower than that of the controls 16 （3-24） days. In 2 children with PHHI, the postoperative level of fasting blood glucose was higher than that pre-operation while the postoperative level of fasting insulin was lower than that pre- operation. The follow-up duration period was 4 to 29 months. During follow-ups, the levels of blood glucose and insulin were normal in two patients with PHHI. There was no postoperative onset of pancreatic fistula, pancreatic bleeding or recurrence. Conclusions SILS is both safe and efficacious in the treatment of pancreatic diseases in children.