腹腔镜阑尾切除术与开腹阑尾切除术治疗急性阑尾炎比较

目的 对比分析腹腔镜阑尾切除术(LA)与开腹阑尾切除术 (OA)治疗急性阑尾炎的疗效.方法 分析185例急性阑尾炎患儿的病例资料.其中85例患儿实施LA(LA组),术后病理证实单纯性阑尾炎30例,化脓性阑尾炎36例,坏疽穿孔阑尾炎19例;另外100例同期行OA患儿作为对照组(OA组),术后病理证实单纯性阑尾炎28例,化脓性阑尾炎38例,坏疽穿孔阑尾炎34例.比较不同类型急性阑尾炎患儿行LA及OA的手术时间、术后肛门排气时间、住院时间,发生腹腔脓肿、切口感染、肠梗阻例数.结果 单纯性阑尾炎、化脓性阑尾炎患儿行LA的术后肛门排气时间、住院时间短于OA组,手术时间长于OA组,差异均有统计学意义(Pa<0.05).坏疽穿孔阑尾炎患儿行LA的术后肛门排气时间短于OA组,差异有统计学意义(P<0.05);手术时间与OA组比较,差异有统计学意义(P<0.05);发生腹腔脓肿、切口感染例数均低于OA组,差异均有统计学意义(Pa<0.05).结论 对于单纯性和化脓性阑尾炎,LA在缩短住院时间、肛门排气时间,降低发生腹腔脓肿、术后切口感染、发生肠梗阻方面存在优势,但对于坏疽穿孔阑尾炎,LA在缩短肛门排气时间,降低发生腹腔脓肿及切口感染方面存在优势.     

经腹腔镜与经腹阑尾切除术治疗的对照分析

目的 探讨腹腔镜阑尾切除术治疗小儿化脓性及坏疽阑尾炎的疗效。方法 回顾性分析应用腹腔镜及经腹行阑尾切除术治疗化脓及坏疽阑尾炎病人各380例。每组均含242例化脓性阑尾炎及138例坏疽性阑尾炎。结果 开腹阑尾切除术组术后腹盆腔脓肿、围术期机械性肠梗阻及伤口感染的发病率分别为21／380、19／380和24／380，均显著高于腹腔镜阑尾切除术组的10／380、6／380和2／380，经统计学分析均有显著性差异。结论 经腹腔镜阑尾切除术较经腹阑尾切除术可显著降低化脓性及坏疽性阑尾炎术后并发症的发生率。     

经脐单孔法腹腔镜阑尾切除术120例

目的 总结经脐单孔法腹腔镜阑尾切除术的临床经验及疗效.方法 对120例阑尾切除术患儿采取自脐孔置入单孔腹腔镜,将阑尾拖出体外进行常规切除的方法 完成手术.结果 120例患儿中,急性单纯性阑尾炎36例,急性化脓性阑尾炎67例,坏疽性阑尾炎15例,阑尾脓肿2例.105例行单孔法腹腔镜手术获得成功,12例改为两孔法,3例中转开腹手术.患儿均治愈,7例术后出现脐部感染.结论 单孔法腹腔镜下阑尾切除术具有创伤小,痛苦少,康复快,隐蔽性及美容效果好等优点,值得临床推广.     

经脐“︺”形切口阑尾切除术治疗小儿阑尾炎的疗效

目的探讨经脐"︺"形切口小儿阑尾切除术治疗小儿阑尾炎的临床疗效。方法回顾性分析42例急性阑尾炎患儿行经脐"︺"形切口小儿阑尾切除术的临床资料,其中男23例,女19例;年龄3～14岁,平均6.5岁。急性单纯性阑尾炎18例,慢性阑尾炎急性发作3例,急性化脓性阑尾炎18例,急性坏疽性阑尾炎3例,坏疽并穿孔2例。采用硬膜外麻醉或加基础麻醉,进行经脐"︺"形切口小儿阑尾切除术。结果 41例手术成功,1例改腹腔镜手术,手术时间15～70 min,平均37 min。术后住院3～7 d,平均4.1 d。30例切口轻微红肿,10例脐窝有积液,2例切口感染换药,所有切口愈合后外观满意,无粘连性肠梗阻、阑尾残株炎、粪漏、腹腔脓肿等并发症的发生。结论经脐"︺"形切口小儿阑尾切除术安全有效,适应证宽,损伤小,费用低,且美容效果好。     

小儿异位阑尾炎诊治36例报告

目的　总结 36例小儿异位阑尾炎的诊断及治疗经验。方法　分别行麦氏切口和探查切口证实腹膜外阑尾 11例 ,高位阑尾 6例 ,盆腔阑尾 18例 ,壁内阑尾 1例。其中单纯性 4例 ,化脓性 12例 ,坏疽穿孔 13例 ,阑尾周围脓肿 7例。结果　均行阑尾切除术 ,2 2例行腹腔引流 ,术后并发腹腔脓肿 7例、肠梗阻 2例、伤口感染 4例 ,均治愈。结论　小儿异位阑尾炎术易发生多种并发症影响康复 ,而及时诊断、妥善处理是防止术后并发症的关键。     

儿童阑尾周围脓肿腹腔镜Ⅰ期手术疗效分析

目的:探讨运用腹腔镜Ⅰ期阑尾切除术治疗儿童阑尾周围脓肿的临床疗效。方法:收集2017年5月至2020年4月在福建医科大学附属漳州市医院接受腹腔镜Ⅰ期阑尾切除术治疗的269例儿童复杂性阑尾炎患儿的相关资料。其中,男181例,女88例;将45例儿童阑尾周围脓肿患儿作为A组,224例同期收治的其他复杂阑尾炎(化脓性、坏疽性或...     

小儿阑尾周围脓肿的腹腔镜手术治疗

目的探讨腹腔镜手术治疗小儿阑尾周围脓肿的治疗效果。方法选择经B超诊断为阑尾周围脓肿的患儿125例,男60例,女65例,年龄2.5-15岁,行腹腔镜探查手术,根据术中情况行腹腔镜下阑尾切除术、腹腔引流术。结果本组125例完成腹腔镜下阑尾脓肿切除术,并放置腹腔引流管。手术时间102.3±18.7min。无1例中转开腹,术后恢复顺利,术后0.9±0.6d排气,1.4±0.2d排便,1.5±0.6d全部病例体温正常,白细胞计数于术后3.4±1.2d恢复正常,引流持续时间2.4±0.3d,术后6.9±1.6d出院。随访2-8个月,无残余腹腔脓肿及粘连性肠梗阻。结论腹腔镜手术治疗是小儿阑尾周围脓肿的有效治疗手段。     

二孔法腹腔镜辅助阑尾切除术治疗小儿阑尾炎

目的总结二孔法腹腔镜下阑尾切除术的经验。方法实施二孔法腹腔镜下阑尾切除术56例,其中急性单纯性阑尾炎34例;急性化脓性阑尾炎18例;慢性阑尾炎4例。采用脐窝上缘10mm和耻骨联合上缘4mm切口进行手术。结果本组均一期痊愈出院,平均住院时间4.3d（3～6d）,除1例脐部切口感染外无其他并发症。结论二孔法腹腔镜辅助阑尾切除术适用于部分急性单纯性阑尾炎、早期化脓性阑尾炎及慢性阑尾炎。     

二孔法儿童微型腹腔镜阑尾切除术

目的 探讨二孔法儿童微型腹腔镜阑尾切除术MLA的可行性及优越性。方法 本组对31例急性阑尾炎患儿行二孔法MLA。术中在脐部和右下腹二孔置入微型腹腔镜器械，将阑尾自5．5mmTrocar孔拖出，体外结扎系膜，切除阑尾，再将阑尾残端回纳腹腔，腹腔镜观察腹腔无异常后，切口对合粘贴。结果 本组31例患儿手术时间25～35min，平均30min，术后8～12h患儿开始饮水，10～12h即可下床活动，术后3～5d均痊愈出院。无切口及腹内并发症。结论 二孔法儿童微型腹腔镜阑尾切除术方法简便，比三孔法腹腔镜阑尾切除术LA更简单、经济，并发症少，手术时间短，切口更小，瘢痕更小，美容效果更好，适用于儿童急性单纯性阑尾炎。     

小儿阑尾炎腹腔镜治疗的分析

目的 重点探讨小儿阑尾炎腹腔镜治疗的并发症发生情况及防治措施。方法 小儿阑尾炎１００例,男６７例,女３３例,年龄４￣１４岁,单纯性阑尾炎６例,化脓性６４例,坏疽穿孔性３０例,全部病例采取紧闭式气管内麻醉,造成人工气腹,使用电视腹腔镜,以内或电凝及套扎方法完成阑尾切除术。结果 术中阑尾动脉出血１例,腹膜前气肿１例,大网膜气囊肿１例,术后腹腔内感染２例,脐部穿刺孔疝１例,均经相应处理。１００例中有９８     

腹腔镜手术与开腹手术治疗儿童复杂性阑尾炎的疗效比较

目的对比分析腹腔镜阑尾切除术（1apamscopicappendectomy,LA）与开腹阑尾切除术（openappendectomy,OA）治疗儿童复杂阑尾炎的临床疗效。方法回顾性分析本院自2014年6月至2015年2月收治的45例儿童复杂阑尾炎患者临床资料,根据不同手术方式分为LA组和OA组,其中LA组21例,OA组24例,比较两组术中出血量、手术时间、术后肠功能恢复时间及住院时间、切口感染、腹腔脓肿及直肠刺激症状的发生率及留置腹腔引流的比率等。结果本组45例均痊愈。LA组手术时间（88．6±20．1）min,OA组手术时间（84．1±10．2）min,两组差异无统计学意义（P=0．340）。LA组有2例中转开腹手术。LA组术中出血（14±10．2）mL,术后肠功能恢复时间（32．6±12．3）h,住院时间（4．2±1．9）d,Troear孔感染率（4．8％）,直肠刺激症状发生率（9．5％）,置腹腔引流率（19．0％）,腹腔脓肿发生率（9．5％）。OA组术中出血（26±9．2）mL,术后肠功能恢复时间（50．6±19．2）h,住院时间（6．2±1．8）d,切口感染率（33．3％）,直肠刺激症状发生率（37．5％）,置腹腔引流率（75％）,腹腔脓肿发生率（37．5％）。两组上述指标比较,差异均有统计学意义（P值分别为：0．000,0．001,0．001,0．044,0．029,0．000,0．029。所有患儿术后随访4～12个月,无一例发生阑尾残株炎、肠瘘及粘连性肠梗阻等并发症。结论腹腔镜手术治疗儿童复杂阑尾炎,安全有效,术后并发症少,有利于患儿术后康复。     

The ectopic appendicolith from perforated appendicitis as a cause of tubo-ovarian abscess

Acute appendicitis is a common surgical cause of abdominal pain in the pediatric population. History and physical examination are atypical in up to a third of patients. Known potential complications of untreated or delayed management of acute appendicitis include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. We report an unusual complication of perforated appendicitis. A tubo-ovarian abscess developed secondary to appendicolith migration into the right fallopian tube in a patient who had undergone interval laparoscopic appendectomy for perforated appendicitis. The retained appendicolith was visualized within the obstructed and dilated fallopian tube on contrast-enhanced CT. We discuss the CT imaging features of this unusual complication of perforated appendicitis.     

双钩套扎针辅助小儿单孔腹腔镜阑尾切除术

目的 介绍双钩套扎针经腹壁穿刺技术辅助小儿单孔腹腔镜阑尾切除术.方法 2015年9月至2016年2月,我中心对25例小儿单纯性和化脓性阑尾炎患儿,术前彩超均可探及阑尾回声,阑尾直径0.6～1.5 cm.男15例,女10例;年龄3～12岁,平均8.5岁.病例包括急性单纯性阑尾炎11例,急性化脓性阑尾炎8例,慢性阑尾炎6例.采用双钩套扎针辅助单孔腹腔镜阑尾切除术.术中经脐单孔腹腔镜监视下,将双钩套扎针钩挂结扎线经右下腹横纹穿刺,在同一穿刺点经腹壁分次带入结扎线,分别结扎阑尾根部和远端、以及阑尾系膜,然后电钩离断并取出病变阑尾.结果 25例患儿均采用该技术成功切除阑尾.手术时间30～55 min,平均(36±5.69) min.全部患儿术后6～12 h可自行下床活动;术后1d恢复胃肠功能并进流食.住院2～6d(平均3.5d).经1～6个月随访,患儿均无切口感染、粘连性肠梗阻、盆腔脓肿等并发症发生.结论 采用双钩套扎针辅助小儿单孔腹腔镜阑尾切除术是一种安全有效的简便方法,可消除单纯经脐部操作的筷子效应,是治疗不包裹阑尾炎又一选择性技术.     

A PLEA FOR INCIDENTAL APPENDECTOMY IN PEDIATRIC PATIENTS WITH MALIGNANCY

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.     

Laparoscopic appendectomy is a favorable alternative for complicated appendicitis in children

Laparoscopic appendectomy in children is a generally accepted procedure for the treatment of non-complicated acute appendicitis. Nevertheless, the role of laparoscopy in complicated appendicitis is more controversial. The objective of this study was to examine the safety, efficacy and complications of laparoscopy in children with complicated appendicitis. This is a retrospective review of the children who underwent laparoscopic appendectomy for complicated appendicitis at King Khalid University Hospital, Riyadh, Saudi Arabia between January 1998 and March 2006. Complicated appendicitis includes perforated appendicitis, gangrenous appendicitis and appendicular masses found intra-operatively. Data collected include demographic, duration of symptoms, operative time, analgesia, complications, length of hospitalization and histopathology. Laparoscopic appendectomy was done by three trocar technique in all cases. During the study period, 59 children aged 3–12 years underwent laparoscopic appendectomy for complicated appendicitis. There were 34 patients with perforated appendicitis, 12 patients with gangrenous appendicitis and 13 patients with appendicular mass. The average operating time was 62 min. The average length of hospitalization was 5 days. The post-operative narcotic analgesic requirement was minimal. Laparoscopy was converted to open surgery in two patients (3.38%). These two cases were excluded from further analysis. Four out of 57 patients (7.01%) had post-operative complications. Three patients (5.26%) developed wound infection. One patient (1.75%) developed haematoma at umbilical port site. There was no post-operative intra-abdominal collection. Laparoscopic appendectomy is a safe alternative for the treatment of complicated appendicitis. It does not increase the incidence of complications even with complicated appendicitis. Contrary to the previous studies, we did not have increased incidence of intra-abdominal collection in this review. However, prospective randomized controlled trials are needed to verify these findings.     

Port-exteriorization appendectomy (PEA): a preliminary report

 Between 1994 and 1999, 121 patients with the clinical diagnosis of acute appendicitis were operated upon at our institute, 70 by conventional appendectomy and 51 by laparoscopic procedures. There were no significant differences in the demographic data, but the percentage of complicated appendicitis operated upon laparoscopically (47%) was higher than in those operated upon conventionally (35.6%). In 13 children a new laparoscopy-assisted technique was used, which entails exteriorization of the inflamed appendix via a right-iliac-fossa port and a complete appendectomy outside the abdominal cavity. The new technique proved to be useful in all types of appendiceal pathology; there were shorter operative times and hospital stays and it avoids the drawbacks associated with operating in complicated appendicitis. Accepted: 9 March 2000     

Scrotal abscess following appendectomy

Postoperative infectious complications in children following perforated appendicitis present in diverse ways. We present two unusual complications of appendectomy for perforated appendicitis: an acute scrotum after open and laparoscopic appendectomy. A␣retrospective review of two cases of scrotal abscess following appendectomy at our hospital as well as a MEDLINE search was performed to review the clinical presentation, etiology, type of treatment, and outcome of these patients. Although scrotal inflammation occurring postoperatively in a patient with perforated appendicitis may be due to an incarcerated hernia, it is much more likely to be due to a scrotal abscess. Patients without a patent processus vaginalis or inguinal hernia at initial presentation of peritonitis must be carefully followed in the postoperative period and explored early if testicular or scrotal pain becomes manifest. Accepted: 2 August 2000     

Peritoneal taurolidine lavage in children with localised peritonitis due to appendicitis

Despite aggressive surgical treatment, rational antibiotic therapy, and modern intensive care, generalised peritonitis remains a major threat in the paediatric age group. Several adjuvant strategies such as peritoneal saline lavage and peritoneal drainage have been utilised. Taurolidine, derived from the amino acid taurine, has bactericidic, antiendotoxic, and antiinflammatory properties. It has been introduced previously for intraoperative peritoneal lavage in treating peritonitis in adults. The aim of our study was to evaluate the effect of peritoneal taurolidine lavage on the clinical course and serological inflammation markers in children with perforated appendicitis and localised peritonitis. A series of 27 children presenting with appendicitis between January 1999 and July 2001 were included in the study after parental informed consent. All patients underwent open appendectomy. Taurolidine peritoneal lavage was applied in 15 randomly selected children (eight girls and seven boys; mean age 10 years and 10 months). Twelve children received saline peritoneal lavage and served as the control group (six girls and six boys; mean age 9 years and 7 months). Blood was taken preoperatively and on postoperative days 1, 3, 7, and 14. Full blood cell count, C-reactive protein, endotoxin, interleukin-1, interleukin-6, soluble interleukin-2 receptor, tumour necrosis factor , and procalcitonin were investigated to evaluate the serological course of inflammation. Both groups initially presented with severe inflammation as evidenced clinically and serologically. The clinical postoperative course was uneventful in 13/15 patients in the treatment group and 10/12 patients in the control group. The remaining patients presented complications: intraperitoneal abscess or early postoperative bowel obstruction. With regard to the serological inflammatory parameters, no significant differences were found between the two groups except for the soluble interleukin-2-receptor on the 7th postoperative day. In conclusion, the expected reduction of endotoxin levels and inflammatory activity in the treatment group was not evident. A significant advantage of adjuvant peritoneal taurolidine lavage in the surgical therapy of children with localised peritonitis due to appendicitis could not be shown in our study.