儿童阑尾穿孔的腹腔镜阑尾切除术

目的 :探讨儿童阑尾穿孔腹膜炎行腹腔镜阑尾切除术的优缺点。方法 :分析 30例阑尾穿孔并腹膜炎手术治疗患儿的临床资料 ,其中 15例行LA为腹腔镜组 ,15例开腹阑尾切除术为对照组。比较两组病例的手术时间、术后引流时间、住院时间、术后并发切口感染及腹腔残余感染等情况。结果 :15例LA手术时间 30～ 75min ,平均 5 2min ,几乎无出血 ,术中冲洗并吸尽腹腔内脓液后留置腹腔引流 2～ 3d ;切口感染 1例 ,平均住院 7d。对照组 15例手术时间 4 5～ 110min ,平均 6 4min ,腹腔残余感染 3例 ,切口感染 2例 ,肠粘连 1例。结论 :阑尾穿孔并腹膜炎患儿行LA比常规开腹术恢复快 ,住院时间短 ,切口感染及腹腔残余感染发生率明显降低 ,且切口疤痕小 ,美容效果好。阑尾脓肿形成早期不是LA的禁忌证 ,但阑尾脓肿并广泛包裹者不宜行LA。

Laparoscopic appendectomy in children appendiceal perforation

Objective:To study the advantages and disadvantages of laparoscopic appendectomy in treating appendiceal perforation.Methods:The clinical data of 30 cases were analyzed. 15 cases were performed laparoscopic appendectomy (LA), the other 15 cases were performed open appendectomy as control. The operation time, postoperative drainage time, hospitalization postoperative incision infection and left infection in abdominal cavity were compared in the two groups.Results:In the treatment group, the operation time was from 30 to 75 minutes, left abdominal drainage was from 2 to 3 days, hospitalization was 7 days in average, infection was in 1 case. In the control group, the operation time was from 45 to 110 minutes, abdominal left infection was in 3 cases, incision infection in 2 cases, intestinal adhesion was in 1 case.Conclusions:LA has the advantages of quick recovery, short hospitalization, low infection rate, and small scar. Early stage of appendiceal abscess is not contraindication of LA, but appendiceal abscess combined wide encapsulation is not adapted for LA.