腹腔镜手术与开放手术治疗小儿肝囊型包虫病的临床比较  

Clinical efficacy comparison of laparoscopic minimally-invasive procedure versus open operation for hepatic cystic echinococcosis in children

作　　者：刘辉[1] 李万富[2] 樊珈榕[2] 李朝旺[2] 马柱[2] Liu Hui;Li Wanfu;Fan Jiarong;Li Chaowang;Ma Zhu(Xinjiang Medical University,Urumqi 830011,China;DepartmentⅡof Pediatric Surgery,First Clinical Medical College,Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一临床学院,乌鲁木齐830011 [2]新疆医科大学第一附属医院小儿外科二科,乌鲁木齐830011

出　　处：《中华小儿外科杂志》2020年第4期319-324,共6页Chinese Journal of Pediatric Surgery

基　　金：新疆维吾尔自治区自然科学基金(2017D01C321);新疆维吾尔自治区教育厅教育教学改革研究项目(YG2019029)。

摘　　要：目的 探讨腹腔镜手术治疗小儿肝囊型包虫病的治疗效果及安全性。方法 回顾性分析新疆医科大学第一附属医院小儿外科2013年7月至2018年9月收治的102例肝细粒棘球蚴感染的患儿的临床资料。其中,男59例,女43例;年龄范围为3~14岁。根据手术方式的不同分为两组:行腹腔镜手术治疗的48例患儿为腹腔镜组(2016年3月后收治),行传统开放手术的54例患儿为对照组(2016年3月前收治),比较两组患儿的基线资料、手术时间、术中出血量、术后排气时间、术后8 h患儿视觉模拟评分(visual analogue scale,VAS)、术后住院时间、残腔感染率、胆漏发生率、术后高钠血症发生率及复发率等资料,并进行对比分析。结果 两组患儿基线资料、手术时间、残腔积液率、残腔感染率、术后高钠血症发生率、胆漏发生率及复发率对比的差异无统计学意义(P>0.05),而术中出血、术后排气时间、术后8 h VAS评分、以及术后住院时间对比的差异具有统计学意义(P<0.05)。结论 在相应的手术指征下行腹腔镜手术治疗小儿肝囊型包虫病与开腹手术治疗效果相似,且腹腔镜手术具有创伤小、术中视野清楚、住院时间短、术后恢复快、切口美观等优势,安全、可行,患儿家属更容易接受。Objective To assess the efficacy and safety of laparoscopy for pediatric hepatic cystic echinococcosis.Methods Clinical data were retrospectively analyzed for 102 children aged 3-14 years from July 2013 to September 2018.According to different surgical approaches,they were divided into laparoscopic group(n=48)and control group(n=54,traditional laparotomy).Basic profiles,operative duration,intraoperative volume of blood loss,anal exhaust time,visual analogue scale(VAS)score at 8h postoperatively,postoperative hospitalization stay,residual cavity infection rate,bile leakage rate,postoperative hypernatremia rate and recurrence rate were compared and analyzed.Results No statistically significant inter-group differences existed in basic profiles,operative duration,residual cavity effusion rate,residual cavity infection rate,bile leakage rate,postoperative hypernatremia rate or recurrence rate(P>0.05).No statistically significant differences existed in intraoperative volume of blood loss,anal exhaust time,VAS score at 8h postoperatively or postoperative hospitalization stay(P<0.05).Conclusions The efficacies of laparoscopy and open surgery are similar for hepatic cystic echinococcosis in children.Laparoscopy offers the advantages of mini-invasion,shorter postoperative hospitalization stay,distinct surgical field,quicker postoperative recovery and aesthetic incision.It is safe,feasible and more acceptable for parents.

关 键 词：儿童 肝棘球蚴病 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]