儿童腹腔镜阑尾切除术中转开腹多因素分析

Multi-factor analysis of conversion from laparoscopic appendectomy to laparotomy in children

目的 探讨影响儿童腹腔镜阑尾切除术(laparoscopic appendectomy, LA)中转开腹的危险因素。方法 回顾性分析2019年9月-2021年5月郑州大学人民医院小儿外科施行117例LA患儿的临床资料,分析影响儿童LA中转开腹的相关危险因素。结果 8例患儿中转开腹治疗,中转开腹率6.83%,单因素分析显示:阑尾根部穿孔或坏疽、盲肠后位阑尾、粘连致密、弥漫性腹膜炎、CT分级≥4级与中转开腹密切相关(P<0.05);Logistic回归分析显示盲肠后位阑尾、粘连致密是LA中转开腹的独立危险因素。结论 盲肠后位阑尾与粘连致密是儿童LA中转开腹的独立危险因素。术前应合理正确的评估患儿中转开腹的危险因素,选择合适的手术时机及手术方式,减少患儿手术创伤与术后并发症的发生,给患儿带来最优的手术治疗体验。

Objective To explore the related factors influencing the conversion from laparoscopic appendectomy(LA)to laparotomy in children.Methods The clinical data of 117 children with LA performed in the Department of Pediatric surgery of Zhengzhou University people’s Hospital from September 2019 to May 2021 were analyzed retrospectively,and the risk factors affecting the conversion of LA to laparotomy in children were analyzed.Results Among the children with LA,8 cases were converted to lapamrotoy,and the conversion rate was 6.83%.Univariate analysis showed that appendix root perforation or gangrene,posterior cecal appendix,dense adhesion,diffuse peritonitis and CT grade≥4 were closely related to conversion to laparotomy(P<0.05).Logistic regression analysis showed that posterior cecal appendix and dense adhesion were the independent risk factors for conversion to laparotomy in LA.Conclusion Posterior cecal appendix and dense adhesion were the independent risk factors for conversion of LA to laparotomy.The risk factors of conversion from LA to laparotomy should be evaluated reasonably and correctly before operation,and the appropriate operation time and mode should be selected to reduce the occurrence of surgical trauma and postoperative complications,and bring the best surgical treatment experience to children.