小儿腹腔镜阑尾切除术与传统阑尾切除术临床分析

目的探讨腹腔镜阑尾切除术（LA）与传统阑尾切除术（CA）的优缺点。方法回顾性分析2004年1月至2008年10月300例小儿阑尾炎的病例资料，其中LA240例，CA60例。结果两组在手术时间上无明显差异（P〉0．05）。腹腔镜组住院时间短（P〈0．05），术后并发症少。结论LA与CA比较，具有创伤小、恢复快等优点，但术后切15感染和脂肪液化的发生，CA组多于IA组。     

二孔法腹腔镜小儿阑尾切除术体会

我院腹腔镜外科 2 0 0 2年 1～ 8月对14例急性单纯性阑尾炎和蜂窝组织炎性阑尾炎行二孔法腹腔镜阑尾切除手术(laparoscopyappendectomy ,LA) ,取得较好效果 ,现报告如下。临床资料一、一般资料本组 14例 ,男 4例 ,女 10例 ;年龄 5岁 2个月～ 14岁 ,平均 9岁 1个月 ;临床表现为呕吐、腹痛、发热。发病时间 5～18h ,平均发病时间 12h。体检均发现右下腹固定性压痛 ,无明显肌紧张及反跳痛。实验室检查发现 9例白细胞 >10× 10 9/L ,5例在正常范围。根据病史及临床表现诊断小儿急性阑尾炎。术后病理检查确诊为单纯性阑尾炎 8例、蜂窝组织炎 6…     

小儿阑尾脓肿手术治疗20例临床体会

目的通过对小儿阑尾脓肿I期行阑尾切除术,总结外科手术治疗要点及适应证。方法收集本院7年内收治小儿阑尾脓肿52例,其中20例行手术治疗,I期行阑尾切除术。腹腔内用0.5％聚维酮碘生理盐水彻底冲洗并置管引流。术后用第三代头孢菌素,氨基糖甙类及抗厌氧菌类抗菌素抗炎治疗。结果除1例因并直肠穿孔行造瘘外余均恢复良好,平均住院11d,无肠瘘等并发症发生。结论 急性阑尾炎是小儿外科常见疾病,但由于其临床症状不典型,容易误诊而形成阑尾脓肿,按常规方法阑尾脓肿经保守治疗症状无明显好转,脓肿继续增大时应及时切开脓腔置管引流,但我院经对20例阑尾脓肿手术治疗,体会到只要掌握适应证、处理恰当,可以I期行阑尾切除术,以避免患儿第二次手术所带来的痛苦。     

阑尾切除术后消化道出血

病历摘要患儿：男,５岁。以“阑尾切除术后１０ｄ,血便１ｄ”之主诉于１９９８年９月４日急诊入院。入院前１０ｄ,患儿以“化脓性阑尾炎”收住外院并手术治疗。术后抗感染治疗,第４ｄ患儿出现弛张热,体温３９℃以上,且伴有腹泻,为稀水样便。该院给予静脉输液抗感染的同时,口服肠道制菌药,腹泻略有缓解,此后仍反复发作。术后第９ｄ患儿排出暗红色血便,继而出现鲜血便,并可见肉样块排出,共排血便５次,总量约２５０ｍｌ。近１０ｄ来,患儿未进食,小便淡黄,睡眠差。既往无血便史。体检：体温３８．６℃,脉搏９０次／ｍｉｎ,呼…     

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...     

腹腔镜下小儿阑尾切除用微波固化处理阑尾系膜21例报告

腹腔镜阑尾切除手术以其创伤小、痛苦轻、恢复快、腹壁无瘢痕等优点被越来越多的人们所接受。腹腔镜在小儿急性阑尾炎的治疗中也得到了较为广泛的应用。2002年4月至2003年12月问．我院在腹腔镜阑尾切除手术中用微波固化的止血方法处理阑尾系膜及阑尾残端，治疗21例小儿急性阑尾炎，效果满意，现报告如下。     

新生儿急性阑尾炎阑尾穿孔1例

新生儿阑尾炎极为罕见,本院近期收治新生儿急性阑尾炎并阑尾穿孔1例,现报告如下. 患儿,女,17 d,因"腹胀3 d"入院.患儿3 d前开始出现哭闹不安,恶心,呕吐,腹胀,伴发热.     

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.     

经脐部小切口阑尾切除术在小儿外科的应用

目的探讨施行经脐单孔非腹腔镜辅助阑尾切除术治疗小儿阑尾炎的安全性和可行性。方法回顾性分析19例急性阑尾炎患儿行经脐单孔非腹腔镜辅助阑尾切除术的临床资料。结果19例手术均获成功。手术时间15～65min,平均35min。无脐孔感染及其他并发症发生,术后平均住院时间3．8d。结论在严格掌握手术适应证的前提下,经脐单孔非腹腔镜辅助小儿阑尾切除术安全有效,美容效果好。     

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     

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。     

腹腔镜治疗小儿复杂性阑尾炎的临床分析

目的 对比分析腹腔镜阑尾切除术(LA)和开腹阑尾切除术(OA)治疗小儿复杂性阑尾炎的疗效.方法 回顾性分析2004年5月至2010年12月收治的小儿复杂性阑尾炎1008例的临床资料,比较LA组和OA组手术时间、住院费用、腹腔脓肿及切口感染发生率.结果 两组均无手术死亡病例.LA组有24例中转开腹手术,Trocar孔/切口感染发生率(6.1％)较OA组(11.9％)低,差异有统计学意义(P=0.001).术后腹腔脓肿发生率LA组较OA组高(7.4％vs 3.7％),差异有统计学意义(P=0.011).LA组手术时间较OA组长[(54±12)min vs (53±14)min],且费用较OA组高[(7305±426)元vs (7255±435)元],但差异均无统计学意义(P=0.226,P=0.066).结论 LA具有创伤小、恢复快、并发症少、住院时间短等优点,是治疗小儿复杂性阑尾炎安全、有效的手术方式,但术后腹腔脓肿发生率偏高.     

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。     

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。     

Oral Clonidine Premedication Reduces Nausea and Vomiting in Children after Appendectomy

Objective

Clonidine is an α2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting (PONV). We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy.

Methods

Sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendecectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given 4 µg.kg -1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were assessed during 0-24 hours after anesthesia.

Findings

The patients’ characteristics were similar in two groups. Patients who had received clonidine had significantly less episodes of PONV and also less rescue antiemetic usage than patients in control group.

Conclusion

We showed that oral clonidine at a dose of 4 µg.kg -1 administered preoperatively is associated with a reduced incidence of postoperative vomiting in children who have undergone appendectomy.     

某医院20年间阴性阑尾切除调查与分析

目的探讨临床阴性阑尾切除的现状、变迁及影响因素。方法回顾性分析本院1991—2010年所有因诊断急性阑尾炎而接受阑尾切除,术后结合临床和病理诊断明确为阴性阑尾切除的病例资料。①搜集阴性阑尾切除病例基本资料;②按年份分成4组:A组(1991—1995年)、B组(1996—2000年)、C组(2001—2005年)及D组(2006—2010年)。分析各组阴性阑尾切除的发生率,并与同期阑尾穿孔率进行比较;③按年龄分成4组:婴幼儿组(1 d至3岁)、学龄前组(4~7岁)、学龄期组(8~12岁)、青春期组(13~16岁),统计各年龄组患儿阴性阑尾切除率。结果本院20年间共实施阑尾切除术5 469例,其中阴性阑尾切除694例,占同期阑尾切除病例的12.7%。阴性阑尾切除病例中,阑尾误切47例(6.77%);酷似阑尾炎病例647例(93.2%);阴性阑尾切除率从1991—1995年的14.9%下降至2006—2010年的7.58%,P值0.001,提示阴性阑尾切除率呈稳定下降趋势;阴性阑尾切除最多发生于8~12岁患儿,最少发生于0~3岁患儿;男女比例为1:0.9。最常见误诊疾病为肠系膜淋巴结炎、上呼吸道感染、胃肠炎、梅克尔憩室、原发性腹膜炎。结论20年间本院阴性阑尾切除率为12.7%,与阑尾穿孔率相同,均呈稳定下降趋势,大多为酷似阑尾炎疾病,误诊病例少见。     

Pathologic Evaluation of Appendectomy Specimens in Children: Is Routine Histopatholgic Examination Indicated?

Objective

Acute appendicitis is the most common cause of abdominal surgery in children. Similarity between signs and symptoms of appendicitis and other common pediatric illnesses, atypical manifestations of appendicitis in young children, and children''s inability to give precise explanation for their symptoms contribute to considerable delay in proper diagnosis and increased rate of perforation. Current study reports the surgical and pathological findings of appendectomies in the largest Children''s Hospital in Iran. It also evaluates whether common protocol for pathologic evaluation following appendectomy is beneficial.

Methods

Pathologic reports of 947 appendectomies, performed with the presumptive diagnosis of acute appendicitis, were gathered. Correlation between surgical and pathologic findings was assessed. Demographic characteristics of patients between surgical and pathological subgroups were also compared.

Findings

The mean age of participants was 6.9±3.5 years. Eighty seven (25.5%) children had abnormal pathological findings and normal surgical report. None of miscellaneous findings including appendicular carcinoid tumor 3 (0.3%), oxyuriasis 2 (0.2%), and mycobacterial infection 4 (0.5%) were recognizable during the surgery. Of all pathologically confirmed cases with perforated appendicitis, 9.7% were not detected during the surgery.

Conclusion

In current study, acute appendicitis was the most common pathological diagnosis, however, high normal appendectomy rate along with noticeable proportion of surgically missed perforated appendicitis and unusual histopathologies strongly supported routine histological examination.     

2875例小儿腹腔镜阑尾切除术并发症分析及预防对策

目的 探讨小儿腹腔镜阑尾切除术(LA)的并发症及影响因素，提出预防处理对策。方法 2000年9月～2003年7月完成的LA2875例，采用回顾性分析法，对术中、术后并发症及其发生因素进行探讨。结果 LA术中、术后发生的血管损伤2例(0．07％)，阑尾系膜出血3例(0．10％)，腹腔内脓肿21例(0．73％)，术后腹膜粘连致慢性腹痛18例(0．63％)，总计44例，并发症发病率为1．53％。这与疾病的严重程度、手术操作的规范化和熟练程度有关。结论 在正确认识疾病严重程度的基础上，熟练的分离、切割、结扎等技术及操作程序的规范化是保证LA手术安全性和疗效的关键。     

Acute appendicitis in childhood: experience in a developing country

Appendicitis is a common cause of acute abdominal pain in childhood. Four hundred and thirty-six children 15 years of age and younger with histologically proven acute appendicitis were treated surgically over an 11-year period (1983–1993). Epidemiological differences suggested a lower prevalence in the black African and mixed ethnic groups in comparison to Caucasian children. There was no evidence suggesting that appendicitis was an emerging disease in the period under study. Appendicitis occurred at any age, but only 24% of cases presented in the first 8 years of life, the peak incidence being from 11 years onwards. There were 3 neonates in this series who presented in a similar fashion to necrotising enterocolitis. One of these was shown to have Hirschsprung's disease at post-mortem examination. There were no striking differences in the clinical presentation between groups, but a higher incidence of complicated appendicitis was identified in the younger age group and those from poor socioeconomic situations. The male:female ratio was 1.74 overall. A male preponderance was also identified in patients presenting pre- and post-puberty. Seasonal variation was present, with the highest incidence being in the summer months. Intestinal helminths coexisted in 9.4% of cases; the majority were ova of Ascaris lumbricoides. A low incidence of faecoliths was recognised. Clinicopathological correlation showed an incidence of 41% (177 patients) with acute appendicitis, 47% (203) with perforated appendicitis, 4% (20) with a walled-off appendix abscess, and 7% (32) with gangrenous appendicitis. The remaining 1% showed chronic inflammatory changes. A mortality of 0.4% (2 patients) resulted from complications attributable to late diagnosis, generalised peritonitis, and septicaemia.