经脐腹腔镜辅助体外阑尾切除术治疗儿童非复杂性阑尾炎  

Application of Transumbilical Extracorporeal Laparoscopic-assisted Appendectomy in the Treatment of Uncomplicated Appendicitis in Children

作　　者：明安晓[1] 邵一峰 刁美[1] 李颀[1] 李龙[1] Ming Anxiao;Shao Yifeng;Diao Mei(Department of General Surgery,Children’s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院普外科,北京100020

出　　处：《中国微创外科杂志》2025年第3期171-174,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：中国医学科学院小儿外科微创诊疗创新单元(2021RU015)。

摘　　要：目的探讨经脐腹腔镜辅助体外阑尾切除术在儿童非复杂性阑尾炎治疗中的应用价值。方法对2019年1月~2024年10月经脐腹腔镜辅助体外阑尾切除术38例进行回顾性分析。中位年龄7.5岁(2.4~16.3岁),入院前腹痛时间(20.6±10.6)h,术前超声检查阑尾直径(0.92±0.15)cm,15例合并阑尾粪石。脐部纵切口长约1.5 cm,置入5 mm trocar(长约15 cm)和30°腹腔镜,5 mm短trocar(长约9 cm)和操作抓钳,探查腹腔,分离粘连,抓钳抓住阑尾末端,切开两trocar之间的组织,将阑尾提出腹外结扎、切除。结果31例阑尾周围无明显粘连,阑尾提出顺利;7例阑尾周围粘连,腹腔镜下钝性分离后将阑尾末端经脐部切口提出,自阑尾远端游离松解粘连后将阑尾完整提出并完成手术。手术时间(27.1±8.6)min,术后住院时间1~3 d,术后病理诊断急性化脓性阑尾炎32例,坏疽性阑尾炎6例。术后均未使用静脉镇痛药物。电话随访2~68个月,中位数58个月,无腹痛等不适。结论经脐腹腔镜辅助体外阑尾切除术治疗儿童非复杂性阑尾炎疗效确切,切口美观。Objective To evaluate the clinical efficacy of transumbilical extracorporeal laparoscopic-assisted appendectomy(TUELAA)for pediatric uncomplicated appendicitis.Methods A retrospective analysis was conducted on 38 cases treated with TUELAA between January 2019 and October 2024.The median age was 7.5 years old(range,2.4-16.3 years old).The duration of abdominal pain before admission was(20.6±10.6)h.Preoperative ultrasound revealed an average appendiceal diameter of(0.92±0.15)cm,with appendicoliths identified in 15 cases.A vertical umbilical incision approximately 1.5 cm in length was made,through which a 5 mm trocar(15 cm in length)with a 30°laparoscope and a 5 mm short trocar(9 cm in length)with grasping forceps were inserted.The abdominal cavity was explored,adhesions were dissected,and the appendiceal tip was grasped.The tissue between the two trocars was incised,and the appendix was extracted through the umbilical incision for extracorporeal ligation and excision.Results Among the 38 cases,31 had no significant adhesions around the appendix,and the appendectomy was successfully performed with smooth extraction of the appendix.In the remaining 7 cases with adhesions around the appendix,blunt laparoscopic dissection was used to release the adhesions.After the appendix tip was freed,it was extracted through the umbilical incision for complete excision.The surgical time was(27.1±8.6)min,and the postoperative hospitalization was 1-3 d.Pathological diagnoses revealed 32 cases of acute suppurative appendicitis and 6 cases of gangrenous appendicitis.No intravenous analgesics were used postoperatively.No discomfort such as abdominal pain was noted during telephone follow-ups for 2-68 months(median,58 months).Conclusion TUELAA demonstrates definite efficacy and favorable cosmetic outcomes for the treatment of pediatric uncomplicated appendicitis.

关 键 词：非复杂性阑尾炎 儿童 经脐手术 腹腔镜辅助阑尾切除术 

分 类 号：R65[医药卫生—外科学]