改良经脐单孔腹腔镜阑尾切除术的临床分析(附55例报告)

Modified single-port transumbilical laparoscopic appendectomy:clinical analysis of 55 cases

目的:探讨改良经脐单孔腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗青少年及儿童急性阑尾炎的临床应用价值。方法:回顾分析2015年9月至2017年3月为55例急性阑尾炎患儿行改良经脐单孔LA的临床资料,术中使用常规腹腔镜器械操作。结果:55例患儿中50例成功完成手术,5例因化脓、粘连严重中转为三孔法LA,手术成功率90.9%。手术时间平均(45.55±6.33)min,术中出血量平均(5.25±1.10)ml,术后排气时间平均(12.20±4.24)h,平均住院(5.60±1.42)d,55例均治愈出院,无一例发生腹腔残余感染及切口感染。术后病理证实急性单纯性阑尾炎44例,化脓性阑尾炎11例。术后随访3～9个月,无粘连性肠梗阻、脐疝等并发症发生。结论:对于青少年及儿童急性阑尾炎,改良经脐单孔LA优势明显,值得临床推广应用。

Objective：To investigate the effect and value of the modified single-port transumbilical laparoscopic appendectomy in treatment of acute appendicitis in teenagers and children. Methods ： Clinical data of 55 children who suffered from acute appendicitis and underwent modified single-port transumbilical laparoseopic appendectomy from Sep. 2015 to Mar. 2017 were retrospectively ana-lyzed. Conventional laparoscopic instruments were used in the operation. Results： Modified single-port transumbilical laparoseopic ap- pendectomy was successfully performed in 50 of 55 patients with a success rate of 90.9%. 5 cases were converted into three-port meth-od because of suppuration and severe adhesion. The surgery time was （45.55 ± 6.33） rain. The amount of intraoperative bleeding was （5.25 ± 1.10） ml. The postoperative exhaust time was （ 12.20 ± 4.24） h. The hospitalization time was （5.60 ± 1.42） d. All of the 55 patients made a full recovery without abdominal residual infection or incisional infection. The postoperative pathology indicated 44 cases of acute appendicitis and 11 cases of suppurative appendicitis. Patients did not suffer from serious complications such as adhesive ileus, umbilical hernia during the follow-up of 3 to 9 months. Conclusions ： Modified single-port transumbilical laparoscopic appendectomy has its advantages for adolescents and children with acute appendicitis and is worthy of clinical promotion.