CAJ | 학술논문

目的应用3D腹腔镜完成小儿外科常见的不同难度多种手术,总结3D腹腔镜在小儿外科应用的经验和教训.方法回顾性分析从2013年6月至2014年4月采用3D腹腔镜系统完成的56例手术资料,男32例,女24例,年龄6个月至14岁,平均4岁8个月,其中门静脉高压合并脾功能亢进1例,先天性巨结肠及同源病12例,肠重复畸形1例,先天性胆管扩张症8例,食道裂孔疝1例,慢性胆囊炎1例,急性阑尾炎8例,腹股沟斜疝单侧12例、双侧5例,单侧隐睾3例,双侧隐睾4例.就通道建立方法、手术经过、手术时间,围手术期并发症及医生反馈进行分析,并与既往常规腹腔镜进行比较.结果门静脉高压并脾功能亢进患儿中转开放,食道裂孔疝患儿术中食管穿孔,行3D腹腔镜下食道修补术,后期恢复顺利,所有先天性胆管扩张症患儿手术经过顺利.胆囊炎和第一例阑尾周围脓肿增加1枚trocar完成手术.其余患儿均采用单纯经脐3D腹腔镜完成手术.术后随访3～13个月,无围手术期并发症,高难度手术3D腹腔镜下较常规腹腔镜手术用时减少,差异有统计学意义,而中低难度手术时间差异无统计学意义.结论 3D腹腔镜可以在小儿外科顺利开展,适于精细操作,能降低腔镜下手术难度,尤其是利于吻合,可以缩短学习曲线,但是还需要减小直径,改良舒适度,以更加适合小儿外科的需要.
목적 응용3D복강경완성소인외과상견적불동난도다충수술,총결3D복강경재소인외과응용적경험화교훈.방법 회고성분석종2013년6월지2014년4월채용3D복강경계통완성적56례수술자료,남32례,녀24례,년령6개월지14세,평균4세8개월,기중문정맥고압합병비공능항진1례,선천성거결장급동원병12례,장중복기형1례,선천성담관확장증8례,식도렬공산1례,만성담낭염1례,급성란미염8례,복고구사산단측12례、쌍측5례,단측은고3례,쌍측은고4례.취통도건립방법、수술경과、수술시간,위수술기병발증급의생반궤진행분석,병여기왕상규복강경진행비교.결과 문정맥고압병비공능항진환인중전개방,식도렬공산환인술중식관천공,행3D복강경하식도수보술,후기회복순리,소유선천성담관확장증환인수술경과순리.담낭염화제일례란미주위농종증가1매trocar완성수술.기여환인균채용단순경제3D복강경완성수술.술후수방3～13개월,무위수술기병발증,고난도수술3D복강경하교상규복강경수술용시감소,차이유통계학의의,이중저난도수술시간차이무통계학의의.결론 3D복강경가이재소인외과순리개전,괄우정세조작,능강저강경하수술난도,우기시리우문합,가이축단학습곡선,단시환수요감소직경,개량서괄도,이경가괄합소인외과적수요.
Objective To evaluate the application of three-dimensional laparoscopy for pediatric surgery.Methods A retrospective survey was conducted to explore the management of pediatric patients by the 3D/HD Laparoscopic System.From July 2013 to April 2014,52 children with different diseases underwent three-dimensional laparoscopy.There were 30 males and 22 females with an average age of 58 (6-168) months.The causes were inguinal hernia (n =17,12 unilateral & 5 bilateral),cryptorchid (n =7,3 unilateral & 4 bilateral),gallbladder stone with cholecystitis (n =1),acute appendicitis (n =8),portal hypertension (n =1),Hirschprung's disease & Hirschsprung's allied disease (HAD) (n =10),intestine duplication (n =1),choledochocyst (n =6) and hiatal hernia (n =1).Results One boy with spleenectomy and pericardial devascularizztion was converted into open surgery due to giant spleen.The remainder underwent three-dimensional laparoscopy successfully.And transumbilical 3D laparoscopy was performed in 17 cases.The first case of periappendiceal abscess and cholecystitis was completed by one additional trocar.Esophageal perforation was repaired successfully by 3D laparoscopy during hiatal hernia operation.No perioperative complications occurred during the follow-up period.Conclusions The three-dimensional laparoscopy system is both reliable and effective for pediatric surgery.And long-term follow-up is warranted for further evaluations of its efficacy.