3D腹腔镜在小儿外科中的初步应用探讨  

Application of three-dimensional laparoscopy for pediatric surgery

作　　者：余东海[1] 朱天琪[1] 魏明发[1] 张文[1] 冯杰雄[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2014年第11期836-839,共4页Chinese Journal of Pediatric Surgery

基　　金：国家临床重点专科建设项目（2013544）;湖北省自然科学基金（2010CDB054）

摘　　要：目的 应用3D腹腔镜完成小儿外科常见的不同难度多种手术,总结3D腹腔镜在小儿外科应用的经验和教训.方法 回顾性分析从2013年6月至2014年4月采用3D腹腔镜系统完成的56例手术资料,男32例,女24例,年龄6个月至14岁,平均4岁8个月,其中门静脉高压合并脾功能亢进1例,先天性巨结肠及同源病12例,肠重复畸形1例,先天性胆管扩张症8例,食道裂孔疝1例,慢性胆囊炎1例,急性阑尾炎8例,腹股沟斜疝单侧12例、双侧5例,单侧隐睾3例,双侧隐睾4例.就通道建立方法、手术经过、手术时间,围手术期并发症及医生反馈进行分析,并与既往常规腹腔镜进行比较.结果 门静脉高压并脾功能亢进患儿中转开放,食道裂孔疝患儿术中食管穿孔,行3D腹腔镜下食道修补术,后期恢复顺利,所有先天性胆管扩张症患儿手术经过顺利.胆囊炎和第一例阑尾周围脓肿增加1枚trocar完成手术.其余患儿均采用单纯经脐3D腹腔镜完成手术.术后随访3～13个月,无围手术期并发症,高难度手术3D腹腔镜下较常规腹腔镜手术用时减少,差异有统计学意义,而中低难度手术时间差异无统计学意义.结论 3D腹腔镜可以在小儿外科顺利开展,适于精细操作,能降低腔镜下手术难度,尤其是利于吻合,可以缩短学习曲线,但是还需要减小直径,改良舒适度,以更加适合小儿外科的需要.Objective To evaluate the application of three-dimensional laparoscopy for pediatric surgery.Methods A retrospective survey was conducted to explore the management of pediatric patients by the 3D/HD Laparoscopic System.From July 2013 to April 2014,52 children with different diseases underwent three-dimensional laparoscopy.There were 30 males and 22 females with an average age of 58 （6-168） months.The causes were inguinal hernia （n =17,12 unilateral ＆ 5 bilateral）,cryptorchid （n =7,3 unilateral ＆ 4 bilateral）,gallbladder stone with cholecystitis （n =1）,acute appendicitis （n =8）,portal hypertension （n =1）,Hirschprung＇s disease ＆ Hirschsprung＇s allied disease （HAD） （n =10）,intestine duplication （n =1）,choledochocyst （n =6） and hiatal hernia （n =1）.Results One boy with spleenectomy and pericardial devascularizztion was converted into open surgery due to giant spleen.The remainder underwent three-dimensional laparoscopy successfully.And transumbilical 3D laparoscopy was performed in 17 cases.The first case of periappendiceal abscess and cholecystitis was completed by one additional trocar.Esophageal perforation was repaired successfully by 3D laparoscopy during hiatal hernia operation.No perioperative complications occurred during the follow-up period.Conclusions The three-dimensional laparoscopy system is both reliable and effective for pediatric surgery.And long-term follow-up is warranted for further evaluations of its efficacy.

关 键 词：3D腹腔镜 小儿外科 外科手术 腹腔镜 

分 类 号：R726.1[医药卫生—儿科]