小儿经脐单孔腹腔镜手术(LESS)2338例病例报告

Retrospective analysis of 2338 pediatric laparoendoscopic single-site surgery(LESS) cases

目的:探讨小儿经脐单孔腹腔镜手术(LESS)的可行性、局限性及技术难点。方法:回顾性收集分析我院2 338例小儿外科经脐单孔腹腔镜手术的临床资料,手术种类有:经脐单孔腹腔镜疝囊高位结扎术、嵌顿疝松解复位后疝囊高位结扎术、经脐单部位肾积水肾盂输尿管离断成形术等。结果:本组2 338例经脐单孔手术全部顺利完成,无1例中转开放或转多孔法。手术时间:腹股沟疝单双侧5～15 min,平均10 min左右,术后6 h恢复正常饮食;术后第1天出院。嵌顿疝单侧25～45 min,平均30 min,3例因可疑肠穿孔放置腹腔引流,2～3 d无发热引流液体清亮拔管。腹腔镜阑尾切除手术时间17～50 min,平均30 min,术中出血5～10 m L,术后当日或次日下地活动,8 h后可进饮,24 h后可进流质,术后3～5 d出院,无不良并发症发生。肾盂输尿管离断成形术手术120～200 min,平均160 min。所有患儿的腹壁切口隐蔽,无切口出血感染等并发症,均达到良好的美容效果。结论:开展经脐单孔腹腔镜手术必须有三孔、多孔法腹腔镜手术的经验基础,初期有一定难度、手术操作局限性及手术风险,随着病例的增多,利用适当器械不断总结经验,提高手术技巧,可达到更加微创与更好的腹部美容效果。

Objective:To investigate the availability,limitations and technical difficulties of the transumbilical laparoendoscopic single-site surgeries(LESS)on pediatric patients.Methods:The clinical data of 2 338 pediatric cases performed transumbilical laparoendoscopic single-site surgeries was collected and analyzed retrospectively.The surgical methods include:transumbilical laparoendoscopic single-site high ligation of hernia sac surgeries,high ligation of hernia sac after lysis and reduction of incarcerated hernia and transumbilical single-site pyeloureteroplasty for hydronephrosis etc.The operating skills of transumbilical single-site surgery and the invention of new instruments were explored.Results:The 2338 cases of transumbilical single-site surgeries were completed successfully.None of them was transmitted to open or multiple-sites surgeries.Operation duration:For unilateral and bilateral inguinal hernia patients:5-15 min,about 10 min on average,normal dietary was achieved 6 hours after the surgeries;the patients were discharged the first days after the surgeries.For unilateral incarcerated hernia patients:25-45 min,30 min on average,peritoneal drainage were placed in 3 cases because of suspected intestinal perforation,the drainages were removed 2-3 days after the surgeries if the patient was without fever and clear drained fluid was found.The operation duration of laparoscopic appendectomy was 17-50 min,30 min on average,the total volume of bleeding during the operations was 5-10 mL,the patients could walk around on the right days or the first days after the surgeries,they could drink 8 hours after the surgeries and liquid diet was available 24 hours after the operations.The patients were discharged 3-5 days after surgeries with no complications.The operation duration for pyeloureteroplasty was 120-200 min,160min on average.Sound cosmetic effects were achieved with the hidden abdominal incisions and without hemorrhage and infection.Conclusion:The experience of three-site and multiple-site surgeries was needed for the laparoendoscopic single-site surgeries.Some difficulties,limitations and risks were found on the initial stage of the development of the surgeries.However,with the increasing experience and the improvement of surgical skills of the surgeons,the minimal invasive surgical method will bring better abdominal cosmetic effects compared to the traditional ones.