儿童阑尾炎合并鞘状突未闭行单孔腹腔镜联合手术的临床体会

目的:探讨脐部单孔腹腔镜联合手术治疗儿童急性阑尾炎合并鞘状突未闭的优越性及临床应用价值。方法:在脐部单孔腹腔镜手术治疗儿童腹股沟斜疝、急性阑尾炎的基础上,2003年6月至2012年6月为74例急性阑尾炎合并鞘状突未闭患儿行脐部单孔腹腔镜联合手术。结果:74例手术均获成功,无中转开腹。术后早期1例发生腹腔内感染,抗感染治疗后痊愈。随访6～36个月,早期行腹腔外缝合的患儿中1例于术后1个月缝合线感染,迁延不愈,术后3个月拆除缝线后治愈,随访未发生腹股沟斜疝;中期应用可吸收缝线腹腔内缝合的患儿中1例3个月后同侧发生腹股沟斜疝,再次手术治愈;余者及后期改用医用涤纶缝合线的患儿均无其他并发症及腹股沟斜疝发生。结论:脐部单孔腹腔镜联合手术治疗儿童急性阑尾炎合并鞘状突未闭安全、有效,术后腹壁无明显手术瘢痕,值得临床推广应用。

The experience of single-port laparoscopic combined surgery for patent processus vaginalis and appendicitis in children

Objective：To discuss the advantages and clinical value of transumbilical single-port laparoscopic surgery in the treatment of patent processus vaginalis and acute appendicitis in children.Methods：Based on the experience of trans-umbilical single port laparoscopic treatment for the indirect inguinal hernia and acute appendicitis in children,74 children with patent processus vaginalis and acute appendicitis underwent transumbilical single-port laparoscopic surgery during Jun.2003 and Jun.2012.Results：All the operations were well done without conversion to laparotomy.Only one patient got intra-abdominal infection during early hospitalization,and recovered after antibiotic therapy.Patients were followed up for 6-36 months.In one patient of early stage,the suture was removed 3 months after operation because of suture related infection,and no indirect inguinal hernia occurred during follow-up.In another case of middle stage,indirect inguinal hernia in the same side developed 3 months after intra-abdominal suture with absorbable thread,and another operation was performed.No other complications and indirect inguinal hernia were found in other patients of middle stage or all the children who used medical polyester suture at later stage.Conclusions：The transumbilical single-port laparoscopic combined surgery for patent processus vaginalis and acute appendicitis in children is safe and effective,with no visible scar on the abdominal wall.This procedure is recommended when patent processus vaginalis is found during laparoscopic exploration.