腹腔镜阑尾切除术后结扎夹致儿童腹痛7例分析  

Abdominal pain in children caused by ligating clips after laparoscopic appendectomy:an analysis of 7 cases

作　　者：邵一丹 黄磊 倪同磊 SHAO Yidan;HUANG Lei;NI Tonglei(Department of General Surgery,Nanjing Children's Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院普通外科,江苏南京210008

出　　处：《腹腔镜外科杂志》2024年第5期375-377,383,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨儿童腹腔镜阑尾切除术中使用结扎夹处理阑尾残端造成术后长期右下腹疼痛的原因及对策。方法:回顾分析2019年1月至2023年3月收治的腹腔镜阑尾切除术后长期右下腹疼痛再次手术的7例患儿的临床资料,分析其发病原因,总结手术经验与体会。结果:7例患儿中男3例,女4例,平均(11.30±2.07)岁;患儿均顺利完成腹腔镜下回盲部结扎夹取出术,手术时间平均(72.14±24.98)min,术中出血量均小于5 mL。病理检查提示结扎夹上少量组织均未见大量炎性细胞浸润,排除阑尾残端炎。术后7例患儿腹痛症状均消失,平均住院(6.29±1.98)d后顺利出院。随访6个月至4年,未发现再次右下腹疼痛。结论:儿童腹腔镜阑尾切除术中使用结扎夹处理阑尾残端有术后发生右下腹疼痛的风险,可从手术操作、结扎夹的位置与数量方面加以预防。Objective:To investigate the causes and countermeasures of postoperative persistent right lower quadrant abdominal pain in children undergoing laparoscopic appendectomy(LA)using ligating clips for the appendiceal stump closure.Methods:A retrospective study was conducted on the clinical data of 7 children who underwent reoperation due to persistent right lower quadrant abdominal pain after LA from Jan.2019 to Mar.2023.The etiology and surgical experiences were analyzed and summarized.Results:Among the 7 patients,3 were male and 4 were female,with the average age of(11.30±2.07)years.All 7 children successfully underwent laparoscopic ileocecal ligating clip removal surgery,with an average operation time of(72.14±24.98)min and blood loss less than 5 mL.Pathological examination suggested that no significant inflammatory cell infiltration was in the small amount of tissue on ligating clips,ruling out appendiceal stump inflammation.Postoperatively,all 7 children were free of abdominal pain and were discharged from hospital smoothly after an average hospital stay of(6.29±1.98)d.During a follow-up period of 6 months to 4 years,no recurrent right lower quadrant abdominal pain were found.Conclusions:There is a risk of postoperative right lower abdominal pain when using ligating clips to secure the appendiceal stump in children undergoing LA,which can be avoided by the operation during surgery,the position and the number of ligating clips.

关 键 词：阑尾炎 阑尾切除术 腹腔镜检查 结扎夹 腹痛 儿童 

分 类 号：R656.8[医药卫生—外科学]