常规器械行单孔腹腔镜手术在儿童普通外科疾病中的临床应用初探  

The application of conventional instruments in single-port laparoscopic surgery in children

作　　者：兰梦龙 曾纪晓 刘斐 柴成伟 王哲 徐晓钢 陶波圆 梁子建 罗媛圆 叶志华 Lan Menglong;Zeng Jixiao;Liu Fei;Chai Chengwei;Wang Zhe;Xu Xiaogang;Tao Boyuan;Liang Zijian;Luo Yuanyuan;Ye Zhihua(National Children′s Regional Medical Center, Guangzhou Women and Children′s Medical Center, Guangzhou 510120, China)

机构地区：[1]国家儿童区域医疗中心,广州市妇女儿童医疗中心,广州510120

出　　处：《中华腔镜外科杂志（电子版）》2021年第6期353-358,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金(82170528);广东省自然科学基金(2018A030313570)。

摘　　要：目的探讨使用常规器械行单孔腹腔镜手术(single-port laparoscopic surgery,SPLS)在小儿普通外科疾病中的可行性、安全性。方法回顾性分析2019年5月至2021年4月在广州市妇女儿童医疗中心胃肠外科298例接受常规器械SPLS患儿的临床资料,年龄1月龄至14岁,主要疾病包括先天性巨结肠95例(31.9%)、梅克尔憩室47例(15.8%)、胆总管囊肿18例(6.0%)、先天性肥厚性幽门狭窄18例(6.0%)、肠系膜囊肿16例(5.4%)、卵巢肿物15例(5.0%)、肠重复畸形13例(4.4%)、急性阑尾炎13例(4.4%),其他疾病(如肠套叠、腹部肿物、直肠肛门畸形等)63例(21.1%)。其中既往有手术史者31例(10.4%)。观察手术时间、中转开放率、术中出血量、术后疼痛视觉模拟评分、术后住院时间、手术并发症、术后切口美观情况等指标。结果284例(95.3%)采用常规器械完成SPLS,中转多孔腹腔镜手术1例(0.3%)、中转开放手术13例(4.4%)。随访时间2~24个月,298例均无死亡病例,无切口疝、粘连性肠梗阻、疾病复发等并发症,术后切口美观。结论常规器械SPLS在小儿普通外科常见疾病中安全、可行,未增加手术并发症发生率,术后切口美容效果满意。Objective To explore the feasibility and safety of the application of conventional instruments in single-port laparoscopic surgery(SPLS)of pediatric general surgery.Methods A retrospective review was performed of the operative database at Guangzhou Women and Children′s Medical Center from May 2019 to Apr.2021,looking for all cases that were performed SPLS.The patients were between 1month and 14 years old.The main diseases included 95 cases of Hirschsprung′s disease(31.9%),47 cases of Meckel′s diverticulum(15.8%),18 cases of choledochal cyst(6.0%),and congenital hypertrophic pyloric stenosis.18 cases(6.0%),16 cases of mesenteric cysts(5.4%),15 cases of ovarian tumors(5.0%),13 cases of intestinal duplication(4.4%),13 cases of acute appendicitis(4.4%),63 cases(21.1%)of other diseases(such as intussusception,abdominal mass,anorectal malformation,etc.).Among them,31 cases(10.4%)had a history of surgery.The duration of surgery,intraoperative blood loss,postoperative visual analogue scale was observed,and also the postoperative hospital-stay and the aesthetics and satisfactory of the incision.Results A total of 298 SPLS cases were performed.284 cases(95.3%)were completed with conventional SPLS,and 1 case(0.3%)was completed with multiple-ports laparoscopic surgery.A total of 13 cases(4.4%)converted to open surgery.Intraoperative blood loss has no significant difference,postoperative hospital stay was shortened,and no other complications occurred during and after surgery.Conclusions The conventional instrument SPLS is safe and feasible in the common diseases of pediatric general surgery,without increasing the incidence of surgical complications,and the cosmetic effect of the postoperative incision is satisfactory.

关 键 词：常规器械 单孔腹腔镜 儿童 

分 类 号：R65[医药卫生—外科学]