3D腹腔镜手术治疗小儿阑尾周围脓肿

目的总结3D腹腔镜手术治疗小儿阑尾周围脓肿的临床经验。方法回顾性分析三峡大学第一临床医学院普外科2013年1月至2016年8月26例行3D腹腔镜手术治疗的小儿阑尾周围脓肿病例资料,均采用三孔法腹腔镜手术,局部分离脓腔并清除脓液,分离粘连后找到阑尾,超声刀离断阑尾系膜,双重结扎或夹闭阑尾根部,切除阑尾,经操作孔取出,右侧盆腔留置引流管。结果26例均完成3D腹腔镜下阑尾切除术,无一例中转开腹手术。术中出血量(15.5±3.1)m L,手术时间(45.6±7.8)min,术后住院时间(7.8±1.6)d。操作孔感染1例,腹腔脓肿2例,炎性肠梗阻1例,均经保守治疗痊愈。出院后随访2~24个月,中位随访时间14个月,无一例出现粘连性肠梗阻、营养不良等远期并发症。结论3D腹腔镜手术治疗小儿阑尾周围脓肿术中操作过程的立体感更强,操作更精细,整体安全可行。

Role of three dimensional laparoscopy in the treatment of pediatric appendicural abscess

Objective To explore the clinical experience of three-dimensional(3 D)laparoscopy in treatment of pediatric appendicural abscess.Methods A total of 26 cases of pediatric appendicural abscess underwent laparoscopy from January 2013 to August 2016.Three-Trocar technique was employed.Pus cavity was isolated and appendix located.Ultrasonic knife was used for dissecting appendiceal mesangium.After double ligating,appendiceal root was removed and a drainage tube implanted into right pelvis after local washing.Results Laparoscopic appendectomy was performed successfully in all 26 cases.No open laparotomy was required.The intraoperative blood loss was(15.5±3.1)ml;The operative duration(45.6±7.8)min;The postoperative hospitalization(7.8±1.6)days.There were mild incision infection(n=1),peritoneal inflammatory mass(n=2)and intestinal obstruction(n=1).All complications were cured by non-operative measures.During a median follow-up period of 14(2-24)months,there was no occurrence of such complications as adhesive intestinal obstruction or malnutrition.Conclusion For pediatric appendicural abscess,3 D laparoscopy is much safer by offering a more distinct visual field and a greater spatial sense.