儿童慢性腹痛腹腔镜探查后疗效分析

Retrospective analysis of chronic abdominal pain in children after laparoscopic exploration

目的回顾性分析儿童慢性腹痛腹腔镜探查后的临床疗效,以指导临床对儿童慢性腹痛的治疗。方法 36例慢性腹痛手术患儿,术中疑似阑尾病变者行阑尾切除,相对阴性发现者遵从家属意愿决定是否行阑尾切除,术后随访6个月。结果 31例腹腔镜探查术后腹痛消失,其中30例阑尾切除患儿中28例腹痛消失,6例阴性发现保留阑尾的患儿,3例腹痛消失。阑尾切除与非阑尾切除组复发比例经统计学分析差异有意义(x^2=7.85,P=0.005)。在21例腹腔镜探查阴性的患儿中,阑尾切除和非阑尾切除之间复发比例经统计学分析差异有意义(x^2=5.22,P=0.022)。所有手术患儿术后均无并发症发生。结论对保守治疗无效的慢性腹痛患儿行腹腔镜探查,术后86%的患儿腹痛消失。术后腹痛消失的原因中,阑尾因素可能与儿童CAP有一定的相关性,另外,术中麻醉对中枢神经系统的作用及手术对患儿认知行为的影响也可能起到一定的作用。

Objective To evaluate the outcomes of laparoscopic exploration of chronic abdominal pain （CAP） in children. Methods A total of 36 surgical cases were reviewed. And appendectomy were performed for suspected appendix. Select appendectomy was performed according to parental wishes when positive findings were lacking. Results Positive findings included adhesions around appendix,appendiceal fecalith and mesen- teric lymphadenopathy. Among them ,31 had a postoperative relief of symptoms, including 28 cases of appen- dectomy. Two cases undergoing appendectomy developed abdominal pain within 1 month. Significant difference in recurrence existed between appendectomy and non - appendectomy groups （ P= 0. 02 ）. Negative findings were significantly different between appendectomy and non - appendectomy groups （ P = 0.05 ）. No significant difference existed in the numbers of positive and negative findings in appendectomy group （P = 1 ） Conclusions The symptoms of most CAP children are relieved postoperatively by abdominal exploration. And appendix, anesthetic and psychological effects may play some contributory roles.