腹腔镜手术治疗小儿包裹性阑尾脓肿  

Laparoscopic Appendectomy for Encapsulated Appendiceal Abscess in Children

作　　者：刘向阳[1] 陈磊[1] 李洪涛[1] 李龙[2] 

机构地区：[1]河北医科大学附属沧州市中心医院小儿外科,沧州061001 [2]首都儿科研究所外科,北京100020

出　　处：《中国微创外科杂志》2015年第11期1018-1020,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：国家十一五科技支撑计划课题(项目编号:2006BAI05A06)

摘　　要：目的总结腹腔镜手术治疗小儿包裹性阑尾脓肿的临床经验。方法 2010年6月～2014年6月对36例小儿包裹性阑尾炎行腹腔镜下阑尾切除术。采用三孔法,术中分离脓腔并吸除脓液,寻找到阑尾,结扎离断系膜,双重结扎阑尾根部,切除阑尾,局部冲洗,放置引流管。结果 35例患儿顺利行腹腔镜阑尾切除术,1例因分离粘连肠管时回肠破裂中转开腹。手术时间70～115 min,平均84 min。切口轻度感染2例,切口溢液1例,腹腔炎性包块4例,肠梗阻1例,均经保守治疗痊愈。随访31例,5例失访,2例分别在术后1、2个月因饮食不当导致肠梗阻,经禁食水、洗肠等方法治愈,余无并发症发生。结论腹腔镜治疗小儿阑尾周围脓肿一期完成手术是安全可行的。Objective To summarize our experience of laparoscopic appendectomy for encapsulated appendiceal abscess in children. Methods A total of 36 children with appendiceal abscess between June 2010 and June 2014 underwent laparoscopic appendectomy. Three trocars technique was used. We separated the pus cavity and found the appendix. After ligating and disconnecting the appendix artery,double ligation of the appendix root was performed to cut the appendix,and a drainage tube was placed in the pelvic after local washing. Results Among the 36 children,35 underwent laparoscopic appendectomy successfully,while one was required a conversion to open appendectomy due to ileum rupture when separating intestinal adhesion. The operation time was 70- 115 min（ mean,84 min）. There were 2 cases of mild incision infection,1 case of incision overflow,4 cases of peritoneal inflammatory mass,and 1 case of intestinal obstruction. All of them were cured by conservative treatment. Follow up of 31 cases found2 cases of intestinal obstruction due to improper diet,which were cured after fasting and colon hydrotherapy. No other complications occurred. Five patients were lost of follow-up. Conclusion One-stage operation of laparoscopic appendectomy for appendiceal abscess in children is safe and feasible.

关 键 词：阑尾周围脓肿 腹腔镜手术 小儿 

分 类 号：R726.5[医药卫生—儿科]