腹腔镜手术治疗婴幼儿阑尾脓肿

目的:探讨腹腔镜手术治疗婴幼儿阑尾脓肿的可行性,以及与既往治疗方案相比的优势。方法:回顾分析2011年1月至2011年7月为45例阑尾脓肿患儿行腹腔镜手术的临床资料;患儿7个月～5岁,出现症状至就诊时间为3～10 d,腹部超声均提示阑尾周围脓肿。37例患儿入院后即行急诊手术,余8例患儿入院后保守治疗12～24 h无效后行腹腔镜手术。均采用3孔法(5 mm Trocar),脐部置入腹腔镜,左下腹及耻骨上切口为操作孔,阑尾及系膜均用丝线结扎。如阑尾粗大,耻骨上Trocar更换为10 mm后取出阑尾,必要时经耻骨上切口放置腹腔引流管。术后予以三代头孢联合甲硝唑抗炎,禁食2～3 d,腹腔引流管于术后2～4 d拔除。将同组手术人员完成的40例开腹婴幼儿阑尾脓肿手术及28例阑尾脓肿经抗炎保守治疗好转后择期行腹腔镜阑尾切除术的婴幼儿作为对照,对比患儿围手术期及术后并发症情况。结果:45例手术均获成功,手术时间35～130 min,平均75 min。与开腹手术相比,手术时间两组无显著差异(P>0.05);并发症方面腹腔镜组较开腹组低,差异有统计学意义(P<0.05)。此外,择期腹腔镜组手术时间较腹腔镜组短,但术后并发症发生率差异无统计学意义(P>0.05),而总体住院时间明显延长,两组差异有统计学意义(P<0.05)。结论:只要手术及围手术期处理得当,腹腔镜手术治疗婴幼儿阑尾脓肿是安全可行的。腹腔镜手术在寻找阑尾、处理脓肿及腹腔局部冲洗等方面具有明显优势,因此术后切口感染率、腹腔残余感染率及粘连性肠梗阻发生率均较开腹手术低,从而减少了抗生素的使用时间,利于术后康复。

Laparoscopic minimally invasive surgical treatment for infants and young children with appendiceal abscess

Objective:To investigate the feasibility of laparoscopic operation in treatment of appendiceal abscess in children,and its advantages compared with traditional therapy.Methods:The clinical data of 45 children with appendiceal abscess who underwent laparoscopic surgery from Jan.2011 to Jul.2011 were retrospectively analyzed.The children were 7 months to 5 years old,the time from symptoms appeared to visiting was 3-10 d.Abdominal ultrasound suggested peri-appendiceal abscess in all patients.37 children underwent emergent operation,and 8 children underwent laparoscopic operation after 12-27 h ineffective conservative treatment.3-port method was used with 5 mm Trocar,laparoscope was inserted through umbilicus,and incision at left lower quadrant and suprapubic incision were handing incisions.Appendix and mesenterium were ligated with silk suture.If the appendix was thick,suprapubic port was changed to 10 mm,and abdominal drainage tube was placed through suprapubic incision if necessary.The third generation cephalosporin and metronidazole were used to prevent inflammation,fasting was applied for 2-3 d,abdominal drainage tube was removed 2-4 d after operation.40 infants who underwent laparotomy for appendiceal abscess and 28 infants who underwent selective laparoscopy after anti-inflammatory conservative treatment were enrolled in this study as control groups,their perioperative and postoperative complications were compared.Results:Time of laparoscopic appendectomy [75(35-130) min] and open appendectomy were similar(P>0.05).The complication rate after operation was less in laparoscopic appendectomy than in open appendectomy(P<0.05).The mean operating time of selective laparoscopic appendectomy was shorter than laparoscopic appendectomy,and there was not significant difference of complication rate between the two groups(P>0.05),however the hospital stay of selective laparoscopic appendectomy and laparoscopic appendectomy was significantly different(P<0.05).Conclusions:As long as the surgical and perioperative situations are properly disposed,laparoscopic treatment of appendiceal mass in infants is safe and feasible.Laparoscopic operation has obvious advantages in looking for appendix,treatment of abscess and abdominal focal irrigation,therefore its postoperative incision infection rate,abdominal residual infection rate and adhesive intestinal obstruction rate are lower than those of laparotomy,which decrease the time of using antibiotics,and is profitable for postoperative rehabilitation.