腹壁吻合器在小儿腹腔镜手术中的应用分析

Application of abdominal wall stapler during pediatric laparoscopy

目的探讨在小儿腹腔镜手术中应用腹壁吻合器的可行性及安全性。方法收集2016年6月至2019年6月山东大学齐鲁医院儿外科在腹腔镜手术中应用腹壁吻合器辅助的827例患儿的临床资料。其中,男645例,女182例;年龄为(4.1±2.6)岁。所有患儿中,腹股沟斜疝362例[43.77%(362/827)],年龄为(1.9±1.7)岁;鞘膜积液206例[24.91%(206/827)],年龄为(2.8±1.5)岁;隐睾症68例[8.22%(68/827)],年龄为(1.3±0.9)岁;急性阑尾炎119例[14.39%(119/827)],年龄为(4.9±2.2)岁;卵巢占位性病变28例[3.39%(28/827)],年龄为(6.9±2.6)岁;精索静脉曲张44例[5.32%(44/827)],年龄为(9.2±1.3)岁。结果所有患儿均行经脐单部位腹腔镜手术,术中以具有穿刺、抓取等功能的腹壁吻合器辅助操作,其中1例隐睾症患儿在术中因电凝钩损伤髂外动脉而中转开放手术,1例精索静脉曲张患儿在术中发生精索动脉出血,2例腹股沟斜疝患儿在术中因穿刺致术区腹膜外血肿,其余患儿手术均顺利完成。单侧腹股沟斜疝和鞘膜积液患儿的手术时间均为(5.9±1.3)min,单侧隐睾症患儿的手术时间为(36.4±8.2)min,急性阑尾炎患儿的手术时间为(34.2±6.1)min,卵巢占位性病变患儿的手术时间为(51.8±12.1)min,单侧精索静脉曲张患儿的手术时间为(21.8±3.9)min。所有患儿术后随访的时间范围为6个月至3年,2例腹股沟斜疝患儿在下腹穿刺点发生线结反应,无其他腹壁吻合器相关并发症。结论腹壁吻合器相关的并发症轻微、可控,术后切口隐匿、美观,具有一定的临床优势。

Objective To explore the feasibility and safety of abdominal wall stapler during pediatric laparoscopy.Methods From June 2016 to June 2019,a total of 827 children,645 boys and 182 girls,underwent abdominal wall stapler assisted laparoscopy.There were inguinal oblique hernia[43.77%(362/827)]with an age of(1.9±1.7)years,hydrocele[24.91%(206/827)]with an age of(2.8±1.5)years,cryptorchidism[8.22%(68/827)]with an age of(1.3±0.9)years,acute appendicitis[14.39%(119/827)]with an age of(4.9±2.2)years,ovarian mass[3.39%(28/827)]with an age of(6.9±2.6)years and varicocele[5.32%(44/827)]with an age of(9.2±1.3)years.Results Transumbilical laparoscopy was performed with an assistance of abdominal wall stapler with the functions of puncture and grasping.In one case of cryptorchidism,open operation was performed for an injury of external iliac artery by an electrocoagulation hook.There were spermatic artery hemorrhage during varicocelectomy(n=1)and extraperitoneal hematoma caused by puncture in inguinal oblique hernia(n=2).Other operations were with out complicootions.The average operative duration was(5.9±1.3)min for unilateral inguinal oblique hernia and hydrocele,(36.4±8.2)min for unilateral cryptorchidism,(34.2±6.1)min for acute appendicitis and(51.8±12.1)min for ovarian mass and(21.8±3.9)min for unilateral varicocele.The postoperative follow-up period was 6 to 36 months.Two cases had a reaction of suture and knot at the lower abdominal puncture point of inguinal hernia.No other complications were correlated with using an abdominal wall stapler.Conclusions The complications of abdominal wall stapler are mild and controllable.With concealed incision and better cosmetics,it offers some clinical advantages.