腹腔镜新生儿阑尾切除术疗效分析  

Efficacy analysis of laparoscopic appendectomy in neonates

作　　者：黄华[1] 袁洋 马玲 陈玄玄 张伟博 王鹏[1] 马绍斌 陈琦[1] 冯杰雄[3] Huang Hua;Yuan Yang;Ma Ling;Chen Xuanxuan;Zhang Weibo;Wang Peng;Ma Shaobin;Chen Qi;Feng Jiexiong(Department of General Pediatric Surgery,Third Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Clinical Laboratory Medicine,Third Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]郑州大学第三附属医院小儿普外科,郑州450052 [2]郑州大学第三附属医院检验科,郑州450052 [3]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》2023年第11期1009-1014,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的比较腹腔镜下阑尾切除术(laparoscopic appendectomy,LA)与传统开腹阑尾切除术(open appendectomy,OA)治疗新生儿阑尾炎的临床效果,评估腹腔镜技术在新生儿阑尾炎诊治中的安全性和应用价值。方法收集2005年1月至2022年8月郑州大学第三附属医院收治住院确诊为新生儿阑尾炎45例患儿的临床资料,其中男32例,女13例;年龄为(10.4±2.1)d,年龄范围为1~11 d。按照手术方式的不同分为LA组及OA组。收集两组患儿的术前炎症指标变化,发病至手术时间,术后阑尾离体标本直径、坏疽穿孔率,恢复期炎症指标情况,术后并发症(切口愈合、再次手术、粘连性肠梗阻)情况,术后随访结果。结果45例患儿术后病理均证实为新生儿阑尾炎。两组的术前C反应蛋白、白细胞计数、中性粒细胞计数差异没有统计学意义。LA组的术前C反应蛋白上升的绝对值、发病至手术时间、术中阑尾坏疽率、阑尾穿孔率、术后阑尾离体标本直径、术后第4天或第5天的C反应蛋白、术后总的并发症发生率均显著低于OA组(P<0.05)。术后随访显示家长对手术效果满意情况LA组比例高于OA组(P<0.05)。结论腹腔镜下阑尾切除术治疗新生儿阑尾炎安全可行,能使新生儿阑尾炎患儿得到早期诊断与及时的外科治疗,并能有效改善患儿预后。Objective To compare the clinical outcomes of laparoscopic appendectomy(LA)versus traditional open appendectomy(OA)for neonatal appendicitis,to summarize the management experiences and to evaluate the safety and application value of laparoscopic techniques for neonatal appendicitis.Methods The relevant clinical data were reviewed for 45 neonates hospitalized with confirmed appendicitis from January 2005 to August 2022.There were 32 boys and 13 girls with an average age of(10.4±2.1)(1-11)day.They were divided into two groups of LA and OA according to different surgical approaches.Preoperative changes of inflammatory parameters,time from onset to surgery,intraoperative diameter of appendix,gangrene/perforation rate,postoperative recovery of inflammatory parameters,postoperative complications(incision healing,reoperation and adhesive bowel obstruction)and postoperative follow-up results were compared between both groups.Results Postoperative pathology was confirmed as neonatal appendicitis in all of them.No inter-group statistical differences existed in general profiles(gestational age,proportion of preterm infants,gender ratio,birth weight,postnatal feeding pattern,age of onset&initial symptoms,etc.),preoperative C-reactive protein(CRP)or leukocyte/neutrophil count.Absolute values of preoperative CRP elevation,time from onset to surgery,gangrene/perforation rate of appendix,diameter of appendiceal isolated specimen,CRP values at postoperative Day 4/5 and incidence of postoperative complications were significantly lower in LA group than those in OA group.Postoperative follow-up results:proportion of parental satisfaction with surgical outcomes was higher in LA group than that in OA group.Conclusions Laparoscopic technique is both safe and feasible for neonatal appendicitis.With continuous improvements of clinical and ultrasonographic diagnoses,laparoscopic technique may enable early diagnosis and timely surgery of neonatal appendicitis with better outcomes.

关 键 词：阑尾炎 阑尾切除术 腹腔镜 新生儿 

分 类 号：R726.5[医药卫生—儿科]