改良简易儿童经脐单切口腹腔镜阑尾提出切除术

Single-incision laparoscopic pull-out appendectomy in children

目的：探讨一种简易经济的经脐单切口腹腔镜阑尾提出切除术的手术方法。方法选择30例患儿，其中男性12例，女性18例，年龄3～12岁（平均年龄6．5岁）经家长知情同意随机分为单切口腹腔镜组和多切口腹腔镜组，两组均行阑尾提出切除术。结果全部病例手术时间25～45 min，无中转开腹手术病例。术后6～48 h 肠功能恢复，住院时间3～5 d。住院总费用低于传统腹腔镜手术约30％左右。结论经脐单切口阑尾提出切除术结合传统开腹阑尾切除术和传统3孔腹腔镜阑尾切除术的优点，具有易开展、手术时间短、术后恢复快、住院时间短、总费用低的特点。其需要腹腔镜手术器械少，对手术医生掌握腹腔镜技术要求不高。但不适用于阑尾周围粘连严重病例，需要改传统3孔腹腔镜或者开腹手术。

Objetive To explore a simple and economic approach of trans-umbilical single-incision lap-aroscopic pullout appendectomy in children. Methods A total of 30 children were recruited into research with parental consent.There were 18 boys and 12 girls with an average age of 6.5 （3 ~12）years.And trans-um-bilical simple incision （3 Trocars）laparoscopic pull-out appendectomy was performed. Results The opera-tive duration was 30 ~90 min.None of them converted into laparotomy.Bowel function recovered 6 ~48 h postoperatively and hospital stay lasted for 3 to 5 days.Total cost was around 30% less than traditional laparo-scopic appendectomy. Conclusions With the combined advantages of traditional appendectomy and 3-hole laparoscopic appendectomy,appendectomy may be conveniently performed via a single umbilical incision.It of-fers shorter operation duration,quicker recovery,shorter hospitalization length and lower total cost.Also there are fewer needs for laparoscopic instruments and the learning curve is not too great for novice surgeons.Howev-er,it is contra-indicated for severe appendix adhesion when 3 —hole laparoscopy or laparotomy is required .