CAJ | 학술논문

目的儿童急腹症因病情发展迅速、诊断困难是小儿外科的难点,一旦延误治疗可能产生严重后果,传统的剖腹探查又有较大缺陷,本文拟探讨我科应用单纯经脐腹腔镜(TUL)治疗儿童急腹症的经验和教训.方法本研究回顾性分析我院从2009年9月至2012年8月行单纯经脐腹腔镜手术(TUL)探查儿童急腹症患者共248例,男128例,女120例,年龄2.5～14岁,平均(7.2±2.1)岁,探查指征为:①典型的腹膜炎征象；②肠梗阻征象；③患儿保守治疗无效,症状体征加重；④怀疑肠重复畸形、梅克尔憩室及女童附件囊肿并扭转等疾病；⑤诊断性腹腔穿刺抽出腹腔内不凝的血液、脓液、或者消化液者；⑥诊断不明的腹腔内疾病.手术采用单纯经脐腹腔镜技术,脐下弧形切口,Hason法或穿刺置入5mm trocar后,建立气腹,于切口边缘穿刺置入另一枚5mm trocar,进行探查,视探查情况决定脐环上缘穿刺置入第三枚5mm trocar,行病变切除或其他治疗,必要时改开腹操作.结果共行TUL手术探查248例,术中发现为阑尾炎190例,均采取单纯经脐腹腔镜完成手术；梅克尔憩室及肠重复畸形25例,扩大的脐部切口,提出病变肠段腹腔外操作；腹型紫癜病例12例,其中3例出现肠坏死,预备造瘘处腹壁做小切口行坏死肠段切除并近端造瘘；卵巢囊肿5例,卵巢良性畸胎瘤并扭转1例,卵巢囊肿扭转引发一侧附件及大部子宫梗死1例,行坏死附件及子宫部分切除；回盲部肿瘤2例,小肠系膜淋巴管囊肿2例,外伤致小肠穿孔 3例,均小切口完成手术；粘连性肠梗阻1例；6例未发现其他病灶,顺行阑尾切除.随访时间3～36个月,所有患儿均恢复顺利.结论对于具备手术探查指征的儿童急腹症,只要循环稳定,无明显腹胀,均可行经脐腹腔镜术(TUL)探查,该法可以处理绝大多数病变,即使中转开腹,也因诊断明确,损伤小,恢复快,兼具美容效果. 目的兒童急腹癥因病情髮展迅速、診斷睏難是小兒外科的難點,一旦延誤治療可能產生嚴重後果,傳統的剖腹探查又有較大缺陷,本文擬探討我科應用單純經臍腹腔鏡(TUL)治療兒童急腹癥的經驗和教訓.方法本研究迴顧性分析我院從2009年9月至2012年8月行單純經臍腹腔鏡手術(TUL)探查兒童急腹癥患者共248例,男128例,女120例,年齡2.5～14歲,平均(7.2±2.1)歲,探查指徵為:①典型的腹膜炎徵象；②腸梗阻徵象；③患兒保守治療無效,癥狀體徵加重；④懷疑腸重複畸形、梅剋爾憩室及女童附件囊腫併扭轉等疾病；⑤診斷性腹腔穿刺抽齣腹腔內不凝的血液、膿液、或者消化液者；⑥診斷不明的腹腔內疾病.手術採用單純經臍腹腔鏡技術,臍下弧形切口,Hason法或穿刺置入5mm trocar後,建立氣腹,于切口邊緣穿刺置入另一枚5mm trocar,進行探查,視探查情況決定臍環上緣穿刺置入第三枚5mm trocar,行病變切除或其他治療,必要時改開腹操作.結果共行TUL手術探查248例,術中髮現為闌尾炎190例,均採取單純經臍腹腔鏡完成手術；梅剋爾憩室及腸重複畸形25例,擴大的臍部切口,提齣病變腸段腹腔外操作；腹型紫癜病例12例,其中3例齣現腸壞死,預備造瘺處腹壁做小切口行壞死腸段切除併近耑造瘺；卵巢囊腫5例,卵巢良性畸胎瘤併扭轉1例,卵巢囊腫扭轉引髮一側附件及大部子宮梗死1例,行壞死附件及子宮部分切除；迴盲部腫瘤2例,小腸繫膜淋巴管囊腫2例,外傷緻小腸穿孔 3例,均小切口完成手術；粘連性腸梗阻1例；6例未髮現其他病竈,順行闌尾切除.隨訪時間3～36箇月,所有患兒均恢複順利.結論對于具備手術探查指徵的兒童急腹癥,隻要循環穩定,無明顯腹脹,均可行經臍腹腔鏡術(TUL)探查,該法可以處理絕大多數病變,即使中轉開腹,也因診斷明確,損傷小,恢複快,兼具美容效果.
목적 인동급복증인병정발전신속、진단곤난시소인외과적난점,일단연오치료가능산생엄중후과,전통적부복탐사우유교대결함,본문의탐토아과응용단순경제복강경(TUL)치료인동급복증적경험화교훈.방법 본연구회고성분석아원종2009년9월지2012년8월행단순경제복강경수술(TUL)탐사인동급복증환자공248례,남128례,녀120례,년령2.5～14세,평균(7.2±2.1)세,탐사지정위:①전형적복막염정상；②장경조정상；③환인보수치료무효,증상체정가중；④부의장중복기형、매극이게실급녀동부건낭종병뉴전등질병；⑤진단성복강천자추출복강내불응적혈액、농액、혹자소화액자；⑥진단불명적복강내질병.수술채용단순경제복강경기술,제하호형절구,Hason법혹천자치입5mm trocar후,건립기복,우절구변연천자치입령일매5mm trocar,진행탐사,시탐사정황결정제배상연천자치입제삼매5mm trocar,행병변절제혹기타치료,필요시개개복조작.결과 공행TUL수술탐사248례,술중발현위란미염190례,균채취단순경제복강경완성수술；매극이게실급장중복기형25례,확대적제부절구,제출병변장단복강외조작；복형자전병례12례,기중3례출현장배사,예비조루처복벽주소절구행배사장단절제병근단조루；란소낭종5례,란소량성기태류병뉴전1례,란소낭종뉴전인발일측부건급대부자궁경사1례,행배사부건급자궁부분절제；회맹부종류2례,소장계막림파관낭종2례,외상치소장천공 3례,균소절구완성수술；점련성장경조1례；6례미발현기타병조,순행란미절제.수방시간3～36개월,소유환인균회복순리.결론 대우구비수술탐사지정적인동급복증,지요순배은정,무명현복창,균가행경제복강경술(TUL)탐사,해법가이처리절대다수병변,즉사중전개복,야인진단명학,손상소,회복쾌,겸구미용효과.
Objective To evaluate the application of transumbilical laparoscopy (TUL) in children with acute abdominal pain.Methods A retrospective survey were undertaken to explore the management of pediatric acute abdomen using transumbilical laparoscopy technique(TUL).From Sept 2009 to Aug 2012,248 children with acute abdominal pain were subjected to transumbilical laparoscopy.Ages varied from 2.5 to 14 years,with a mean of 7.2 ± 2.1 years.There were 128 males and 120 females.The symptom of pain presented from 1 day to two weeks.The children presented with typical signs of peritoneal irritation,intestinal obstruction,intestinal perforation,suspected abdominal problem with no improvement.Results All children recovered uneventfully.Of all the 248 cases,190 children with appendicitis were treated by appendectomy without conversion; 12 cases had abdominal allergic purpura with 3 showing bowel necrosis.They were converted to laparoscopic-assisted enterectomy or ileostomy; 25 Meckel's diverticulum and intestinal duplication were treated by resection through enlarging the umbilical incision; 5 cases of ovarian cyst and one ovary benign cystic teratoma were treated by ovariocystectomy; one ovarian cyst torsion resulted in uterine infarction was treated by traditional laparoscopic subtotal hysterectomy; 2 cecal tumor and 2 small bowel mesenteric cyst were converted to laparotomy; one post-appendectomy intestinal obstruction was treated by laparoscopic adhesiolysis (with 2 extra trocars) ; 6 cases had negative appendectomy.Conclusions Transumbilic laparoscopy is a valuable procedure in children with acute abdomen for early diagnosis and treatment and with good cosmetic results.