双钩套扎针辅助小儿单孔腹腔镜阑尾切除术

Single-port laparoscopic appendectomy via an inner two-hooked cannula in children

目的介绍双钩套扎针经腹壁穿刺技术辅助小儿单孔腹腔镜阑尾切除术。方法2015年9月至2016年2月，我中心对25例小儿单纯性和化脓性阑尾炎患儿，术前彩超均可探及阑尾回声，阑尾直径0．6～1．5cm。男15例，女10例；年龄3-12岁，平均8．5岁。病例包括急性单纯性阑尾炎11例，急性化脓性阑尾炎8例，慢性阑尾炎6例。采用双钩套扎针辅助单孔腹腔镜阑尾切除术。术中经脐单孔腹腔镜监视下，将双钩套扎针钩挂结扎线经右下腹横纹穿刺，在同一穿刺点经腹壁分次带入结扎线，分别结扎阑尾根部和远端、以及阑尾系膜，然后电钩离断并取出病变阑尾。结果25例患儿均采用该技术成功切除阑尾。手术时间30～55min，平均（36±5．69）min。全部患儿术后6～12h可自行下床活动；术后1d恢复胃肠功能并进流食。住院2～6d（平均3．5d）。经1～6个月随访，患儿均无切口感染、粘连性肠梗阻、盆腔脓肿等并发症发生。结论采用双钩套扎针辅助小儿单孔腹腔镜阑尾切除术是一种安全有效的简便方法，可消除单纯经脐部操作的筷子效应，是治疗不包裹阑尾炎又一选择性技术。

Objective To explore the application of single-port laparoscopic appendectomy （SPLA） via an inner two-hooked cannula. Methods Between September 2015 and February 2016, single-port laparoseopic appendectomy via an inner two-hooked cannula was conducted for 25 children with appendicitis, including acute simple appendicitis （n = 11）, acute suppurative appendicitis （n = 8） and chronic appendicitis （n = 6）. There were 15 boys and 10 girls with an average age of 8. 5 （3-12） years. Under intraoperative visualization through an umbilical single-port laparoscope, an inner two- hooked cannula with a non-absorbable suture entering abdominal cavity via right abdominal transverse striation. Using an identical anatomical landmark on surface of abdominal skin, mesoappendix was penetrated and root of appendix ligated. And distal appendix and blood vessel in mesoappendix were ligated similarly through the same puncture channel. Appendix and mesoappendix were excised with a laparoscopic electric hook. Results All operations were completed via an umbilical incision 1 cm long and pinhole with a diameter of 1.5 mm on abdominal skin at transverse striation. The average operative duration was （36 ± 5.69） （30-55） min. Abdominal pain subsided at 6-12 hour and feeding resumed at 1 day post-operation. The average hospital stay was 3. 5 （3-6） days. No wound infection, adhesive intestinal obstruction or pelvic abscess occurred during a follow-up period of 1-6 months. Conclusions Both safe and effective, SPLA via an inner two-hooked cannula prevents the chopsticks reaction of instrument clashing via an umbilical approach so that it is an alternative method for pediatric appendicitis with no perforation or abscess formation.