[1]刘雪来** 叶茂 陈震 张震 陈胜男.儿童盲肠后位阑尾腹腔镜切除：附57例报告[J].中国微创外科杂志,2024,01(7):484-487.
　Liu Xuelai,Ye Mao,Chen Zhen,et al.Laparoscopic Appendectomy in Children With Retrocecal Appendicitis: Report of 57 Cases[J].Chinese Journal of Minimally Invasive Surgery,2024,01(7):484-487.
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儿童盲肠后位阑尾腹腔镜切除：附57例报告()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年7期
页码:
484-487
栏目:
临床研究
出版日期:
2024-08-25

文章信息/Info

Title:
Laparoscopic Appendectomy in Children With Retrocecal Appendicitis: Report of 57 Cases
作者:
刘雪来** 叶茂 陈震 张震 陈胜男
(首都儿科研究所附属儿童医院普通外科，北京100020)
Author(s):
Liu Xuelai;  Ye Mao;  Chen Zhen;  et al.
Department of General Surgery, Children Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
关键词:
盲肠后位阑尾; 腹腔镜手术; 阑尾切除术; 儿童
Keywords:
Retrocecal appendix; Laparoscopy; Appendectomy; Children
文献标志码:
A
摘要:
目的总结儿童盲肠后位阑尾行腹腔镜切除的体会。方法2019年10月~2024年2月，三孔法腹腔镜阑尾切除术中证实57例盲肠后位阑尾炎。脐正中切口置入5 mm trocar和30°观察镜，下腹正中膀胱上、脐下3~5 cm左侧腹直肌外缘分别置入5 mm trocar和操作钳，探查找到病变阑尾，结扎阑尾根部，电钩顺切和逆切相结合贴近阑尾离断阑尾头端和体部，若阑尾位于侧后腹膜外，需电钩打开侧后腹膜，显露、松解和离断阑尾。结果57例均获成功。手术时间65~120 min，(85.0±10.5)min。术后8~12 h可自行下床活动，术后0.5~2 d恢复排气并进流食，术后住院3~7 d，平均5.5 d。随访1~18个月，平均5.7月，均无切口感染、粘连性肠梗阻、阑尾残株炎、盆腔脓肿等并发症发生。结论盲肠后位阑尾与盲肠壁贴附紧密，手术时间相对较长。可先结扎阑尾根部，贴近阑尾壁离断阑尾，顺切和逆切阑尾相结合灵活操作。阑尾位于腹膜外时先电钩打开侧后腹膜显露阑尾，顺切和逆切相结合离断阑尾。
Abstract:
ObjectiveTo summarize the experience of laparoscopic appendectomy in children with retrocecal appendicitis.MethodsBetween October 2019 and February 2024, 57 children with retrocecal appendicitis were confirmed in threeport laparoscopic appendectomy operations in this department. A 5 mm trocar and a 30° observation laparoscope were inserted through the umbilical midline incision. A 5 mm trocar and operating forceps were inserted through the midline above the bladder in the lower abdomen and the outer edge of the left rectus abdominis muscle 3-5 cm below the umbilicus, respectively. The laparoscopic forceps were inserted into the abdomen cavity to search and ligate the root of the appendix. An electric hook was used to detach the blind end and body of the appendix with combination of forward and reverse cutting. If the appendix was located outside of retroperitoneum, the electric hook was used to open retroperitoneum aiming to expose the appendix, followed by releasing, detaching and cutting the appendix.ResultsThe operations were successfully completed in all the 57 cases. The operating time was 65-120 min (mean, 85.0±10.5 min). All the patients got out of bed and moved around at 8-12 h after surgery and passed flatus and took liquid diet at 0.5-2 d after surgery. The postoperative hospital stay was 3-7 d (mean, 5.5 d). The followups time ranged from 1 to 18 months (mean, 5.7 months). No complications were noted, including wound infection, adhesive intestinal obstruction, appendiceal stump inflammation or pelvic abscess.ConclusionsThe retrocecal appendix is closely attached to the cecal wall, leading to a relatively long surgical time. During the operation, the root of the appendix should be ligated firstly, and the appendix be detached closely to the appendix wall. The combination of forward and backward appendectomy during the surgery should be emphasized. In case the appendix is located outside of the retroperitoneum, the lateral retroperitoneum should be opened with an electric hook to expose the appendix, and the appendix should be removed by combining forward and reverse cutting.

参考文献/References:

[1]St Peter SD,Ostlie DJ.Techniques of laparoscopic appendectomy for pediatric appendicitis:how I do it.J Laparoendosc Adv Surg Tech A,2021,31(10):1195-1199.
[2]Téoule P,Laffolie J,Rolle U,et al.Acute appendicitis in childhood and adulthood.Dtsch Arztebl Int,2020,117(45):764-774.
[3]孙露新,范莹,谢博,等.单孔腹腔镜阑尾切除术治疗急性肝下异位阑尾炎4例报告.中国微创外科杂志,2019,19(1):87-89.
[4]刘雪来,费川,张永婷,等.双钩套扎针辅助小儿单孔腹腔镜阑尾切除术.中华小儿外科杂志,2016,37(10):762-766
[5]刘雪来,张永婷,费川,等.双钩套扎针辅助小儿单部位腹腔镜阑尾切除术.中国微创外科杂志,2017,17(4):340-343,347.
[6]张创,李索林,刘雪来,等.针式抓钳与双钩套扎针辅助小儿单孔腹腔镜阑尾切除术的对比研究.中华普通外科杂志,2020,35(10):815-816.
[7]Chang PC,Lin SC,Duh YC,et al.Should singleincision laparoscopic appendectomy be the new standard for pediatric appendicitis?Pediatr Neonatol,2020,61(4):426-431.
[8]Goodman LF,Lin AC,Sacks MA,et al.Single site versus conventional laparoscopic appendectomy:some pain for no gain?J Surg Res,2021,264:321-326.
[9]Gates NL,Rampp RD,Koontz CC,et al.Singleincision laparoscopic appendectomy in children and conversion to multiport appendectomy.J Surg Res,2019,235:223-226.
[10]Esparaz JR,Jeziorczak PM,Mowrer AR,et al.Adopting singleincision laparoscopic appendectomy in children:is it safe during the learning curve?J Laparoendosc Adv Surg Tech A,2019,29(10):1306-1310.
[11]Hosokawa T,Tanami Y,Sato Y,et al.Association between the computed tomography findings and operative time for interval appendectomy in children.Afr J Paediatr Surg,2021,18(2):73-78.
[12]Tinkham M,Ziesat M,Straumanis J,et al.Double appendix: implications for the emergency department.J Emerg Med,2021,61(2):180-183.
[13]雷跃华,杨玉辉,王邓超,等.腹腔镜与开腹手术治疗腹膜后位阑尾炎的临床疗效比较.中国普外基础与临床杂志,2017,24(6):747-749.

备注/Memo

备注/Memo:
基金项目：北京市自然科学基金(7222015)；首都儿科研究所所级课题(LCYJ-2023-07)；中国医学科学院小儿外科微创诊疗创新单元(2021RU015)**通讯作者，Email：liuxuelai_steven@163.com
更新日期/Last Update: 2024-10-06