经脐入路在小儿腹部外科手术中的应用

Application of Transumbilical Approach in Abdominal Surgical Diseases of Infants

目的介绍经脐入路开腹术这一微创、美观、经济的手术方法,并与传统开腹术和腹腔镜手术进行比较。方法沿肚脐右侧环形皱襞作半环形切口,最大不超过270°,经腹直肌或中线剪开腹膜,在直视下进行手术操作,可吸收线皮内缝合脐部切口;自2001年1月～2003年12月,22例患儿共行23项手术;手术时间40～170min,无1例需扩大皮肤切口或转为传统开腹术。结果除1例新生儿小肠闭锁出现吻合口瘘外,无其他并发症;术后5～7d痊愈出院,随访3月～2年,切口愈合后美观,无脐疝发生。结论经脐入路安全、简便、美观、微创,适用于多种腹部疾病。今后在扩大手术范围和手术年龄方面仍有前景。

Objective To recommend a minimally invasive, cosmetic and economical transumbilical approach for abdominal surgery, as compared with the traditional abdominal procedure and laparoscopy procedure. Methods Half of the ring fold of right umbilicus was incised circumferentially. The incision usually didn't go beyond 270°. And the peritoneum was entered in the midline or via rectus abdominis muscle. The procedure was completed in the standard open fashion by positioning the incision under the open area , and the periumbilical incision was closed subcutaneously with absorbable string. Since 2001, we have done 22 transumbilical laparotomies, there is need no one converted to traditional incision or extended incision (operating time, 40～170 minutes). Results There was no other complications except 1 anastomotic leak. Discharge 5～7 days after the operation. Followed for 3 monthes～2 years, no umbilical hernia was occurred the incision was cosmetic and the scar was not visible. Conclusions Transumbilical approach is feasible, safe, less invasive and cosmetically superior to the open laparotomy for a broad spectrum of surgical procedures in infants, and it may be useful in older children.