腹腔镜诊治新生儿阑尾炎的体会  

Experience of Laparoscopy in Diagnosis and Treatment of Neonate Appendicitis

作　　者：谭诗坤 黄华[1] 陈琦[1] 郑明军 李晓月 鲁盈 Tan Shikun;Huang Hua;Chen Qi(Department of General Pediatric Surgery, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第三附属医院小儿普外科,郑州450052

出　　处：《中国微创外科杂志》2021年第3期282-285,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜技术诊治新生儿阑尾炎的安全性及可行性。方法回顾性分析2016年1月~2020年8月腹腔镜诊治的17例新生儿阑尾炎资料。脐缘左侧切口置入3 mm trocar和30°腹腔镜探查,于左下腹、右下腹各置入3 mm trocar进无损伤抓钳、电钩,松解粘连,暴露阑尾,电凝离断阑尾动脉及阑尾系膜,结扎阑尾根部后距根部0.5 cm处剪断阑尾,阑尾经trocar内取出,清除残余脓苔、积液,酌情放置引流管。结果行肠粘连松解术13例,术中见阑尾穿孔9例,放置引流管14例。手术时间35~95 min,平均57 min。术中出血量<5 ml。病理诊断坏疽性阑尾炎9例,急性化脓性阑尾炎6例,单纯性阑尾炎2例。术后1~3 d自行排便,术后7~15 d出院,无明显并发症,无切口愈合不良。中位随访29个月(2~56个月),无粘连性肠梗阻、阑尾残株炎、残端漏等发生,生长发育同同龄儿。结论腹腔镜技术诊治新生儿阑尾炎安全可靠。Objective To explore the safety and feasibility of laparoscopic technique in the diagnosis and treatment of neonate appendicitis.Methods Clinical data of 17 cases of neonatal appendicitis diagnosed and treated by laparoscopy from January 2016 to August 2020 were analyzed retrospectively.A 3 mm trocar and 30°laparoscope were inserted into the left incision of the umbilicus to explore the abdominal cavity.Two 3 mm trocars were inserted into the left and right lower abdomen for injury-free grip and electric hook.Then the adhesions were loosened and the appendix was fully exposed.The appendix artery and the appendix mesentery were treated with electric hook,the appendix root was ligated with silk thread,the appendix was cut off about 0.5 cm from its root by scissors,and the appendix was taken out through the trocar hole of the abdominal wall.Then the pus moss in the abdominal cavity was removed,the fluid was sucked out,and the drainage tube was placed as appropriate.Results There were 13 cases of intestinal adhesion lysis,9 cases of appendiceal perforation and 14 cases of drainage tube inserted.The average operation time was 57 min(range,35-95 min).The intraoperative blood loss was less than 5 ml.Pathological diagnosis included gangrenous appendicitis in 9 cases,acute suppurative appendicitis in 6 cases and simple appendicitis in 2 cases.There were no obvious complications and poor wound healing.The median follow-up period was 29 months(range,2-56 months).There was no adhesive ileus,appendicitis or stump leakage.They grew and developed like normal children of the same age.Conclusion Laparoscopic technique is of great safety and value in the diagnosis and treatment of neonate appendicitis.

关 键 词：新生儿 阑尾炎 腹腔镜手术 

分 类 号：R65[医药卫生—外科学]