急诊腹腔镜阑尾切除治疗小儿急性坏疽穿孔性阑尾炎合并直径≤4 cm阑尾周围脓肿  

Emergency Laparoscopic Appendectomy for Pediatric Acute Gangrenous Perforated Appendicitis With Periappendiceal Abscess≤4 cm in Diameter

作　　者：刘雪来[1] 叶茂 郑乐 黄凯坤 陈震[1] Liu Xuelai;Ye Mao;Zheng Le(Department of General Surgery,Capital Institute of Pediatrics Affiliated Children Hospital,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院普通外科,北京100020

出　　处：《中国微创外科杂志》2025年第4期216-221,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市自然科学基金(7222015);北京市卫生健康委员会2024-2025年度“一带一路”国际卫生健康合作项目和世界卫生组织合作中心项目;首都儿科研究所所级课题(LCYJ-2023-07)。

摘　　要：目的总结小儿急性坏疽穿孔性阑尾炎合并直径≤4 cm阑尾周围脓肿实施急诊腹腔镜阑尾切除术的经验。方法2021年1月~2024年8月,对49例急性坏疽穿孔性阑尾炎合并直径≤4 cm阑尾周围脓肿患儿实施急诊三孔法腹腔镜阑尾切除术。经脐正中切口置入5 mm trocar和30°腹腔镜,膀胱上2~3 cm处、左腹直肌外侧缘平脐下缘2~3 cm处分别置入5 mm trocar和操作钳,钝性松解大网膜和肠管粘连,暴露肠管间隙之间的脓肿,吸净脓腔内的积液,显露病变阑尾。松解和显露阑尾后,结扎阑尾系膜和根部,电钩松解和离断阑尾系膜,离断病变阑尾。辅以厄他培南抗炎、术后早期下地活动、超声药物物理透射治疗。结果49例均获成功。手术时间50~150 min,(85.5±10.5)min。术后6~8 h均可自行下床活动,术后1.5~2 d恢复排气并进流食。术后6天复查血常规,白细胞、中性粒细胞和中性粒细胞比率正常,C反应蛋白26~55 mg/L,超声显示回盲部仍可见低密度阴影,最大直径≤2.0 cm,盆底积液深度≤2.0 cm。术后住院6~11 d,平均8.5 d。术后病理回报均为急性坏疽穿孔性阑尾炎伴阑尾周围脓肿。随访6~18个月,平均12.5月,均无切口感染、粘连性肠梗阻、阑尾残株炎和盆腔脓肿等并发症发生。结论小儿急性坏疽穿孔性阑尾炎合并直径≤4 cm阑尾周围脓肿实施急诊腹腔镜阑尾切除术,手术安全,可行。术中寻找和显露阑尾以及松解肠粘连,是手术的关键步骤。Objective To summarize the experience of emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated with periappendiceal abscess≤4 cm in diameter.Methods From January 2021 to August 2024,49 children with acute gangrenous perforated appendicitis complicated by periappendiceal abscess≤4 cm in diameter underwent three-port laparoscopic appendectomy.A 5 mm trocar and a 30°laparoscope were inserted through a supraumbilical midline incision.Two 5 mm trocars with operating forceps were placed at 2-3 cm proximal of the bladder and 2-3 cm below the umbilicus at the lateral edge of the left rectus abdominis.Blunt dissection was performed to release the omentum and intestinal adhesion,exposing the abscess in the intestinal interspace.The pus cavity was aspirated,and the diseased appendix was identified.After freeing and exposing the appendix,the mesoappendix was ligated at its base.The mesoappendix was then divided with an electric hook,and the diseased appendix was removed.Results All the 49 cases were operated successfully.The operative time was 50-150 min,with an average of(85.5±10.5)min.All the patients were able to get out of bed at 6-8 h postoperatively,and resumed flatus and started a liquid diet within 1.5-2 d.Postoperative blood tests on the 6 th day showed normal white blood cell count,neutrophil count,and neutrophil ratio,with C-reactive protein levels ranging 26-55 mg/L.Ultrasound showed a low-density shadow in the cecum with a maximum diameter≤2.0 cm and a pelvic fluid depth≤2.0 cm.The average postoperative hospital stay was 8.5 d(range,6-11 d).Pathological reports confirmed acute gangrenous perforated appendicitis with periappendiceal abscess.Follow-ups for 6-18 months(mean,12.5 months)showed no complications such as wound infection,adhesive bowel obstruction,residual appendiceal stump inflammation,or pelvic abscess.Conclusions Emergency laparoscopic appendectomy for pediatric acute gangrenous perforated appendicitis complicated by periappendiceal abscess�

关 键 词：急性阑尾炎 阑尾周围脓肿 腹腔镜手术 阑尾切除术 小儿 

分 类 号：R72[医药卫生—儿科] R6[医药卫生—临床医学]