摘要
目的:探讨小儿经脐单孔腹腔镜手术(LESS)的可行性、局限性及技术难点。方法:回顾性收集分析我院2 338例小儿外科经脐单孔腹腔镜手术的临床资料,手术种类有:经脐单孔腹腔镜疝囊高位结扎术、嵌顿疝松解复位后疝囊高位结扎术、经脐单部位肾积水肾盂输尿管离断成形术等。结果:本组2 338例经脐单孔手术全部顺利完成,无1例中转开放或转多孔法。手术时间:腹股沟疝单双侧5～15 min,平均10 min左右,术后6 h恢复正常饮食;术后第1天出院。嵌顿疝单侧25～45 min,平均30 min,3例因可疑肠穿孔放置腹腔引流,2～3 d无发热引流液体清亮拔管。腹腔镜阑尾切除手术时间17～50 min,平均30 min,术中出血5～10 m L,术后当日或次日下地活动,8 h后可进饮,24 h后可进流质,术后3～5 d出院,无不良并发症发生。肾盂输尿管离断成形术手术120～200 min,平均160 min。所有患儿的腹壁切口隐蔽,无切口出血感染等并发症,均达到良好的美容效果。结论:开展经脐单孔腹腔镜手术必须有三孔、多孔法腹腔镜手术的经验基础,初期有一定难度、手术操作局限性及手术风险,随着病例的增多,利用适当器械不断总结经验,提高手术技巧,可达到更加微创与更好的腹部美容效果。
Objective:To investigate the availability,limitations and technical difficulties of the transumbilical laparoendoscopic single-site surgeries(LESS)on pediatric patients.Methods:The clinical data of 2 338 pediatric cases performed transumbilical laparoendoscopic single-site surgeries was collected and analyzed retrospectively.The surgical methods include:transumbilical laparoendoscopic single-site high ligation of hernia sac surgeries,high ligation of hernia sac after lysis and reduction of incarcerated hernia and transumbilical single-site pyeloureteroplasty for hydronephrosis etc.The operating skills of transumbilical single-site surgery and the invention of new instruments were explored.Results:The 2338 cases of transumbilical single-site surgeries were completed successfully.None of them was transmitted to open or multiple-sites surgeries.Operation duration:For unilateral and bilateral inguinal hernia patients:5-15 min,about 10 min on average,normal dietary was achieved 6 hours after the surgeries;the patients were discharged the first days after the surgeries.For unilateral incarcerated hernia patients:25-45 min,30 min on average,peritoneal drainage were placed in 3 cases because of suspected intestinal perforation,the drainages were removed 2-3 days after the surgeries if the patient was without fever and clear drained fluid was found.The operation duration of laparoscopic appendectomy was 17-50 min,30 min on average,the total volume of bleeding during the operations was 5-10 mL,the patients could walk around on the right days or the first days after the surgeries,they could drink 8 hours after the surgeries and liquid diet was available 24 hours after the operations.The patients were discharged 3-5 days after surgeries with no complications.The operation duration for pyeloureteroplasty was 120-200 min,160min on average.Sound cosmetic effects were achieved with the hidden abdominal incisions and without hemorrhage and infection.Conclusion:The experience of three-site and multiple-site surgeries was needed fo
作者
刘海金
刘潜
刘金平
黄海金
曾林山
陈枫
李彦
傅忠
LIU Hai-jin;LIU Qian;LIU Jin-ping;HUANG Hai-jin;ZENG Lin-shan;CHEN Feng;LI Yan;FU Zhong(Gannan Medical University 1.The First Affiliated Hospital,Ganzhou,Jiangxi 341000)
出处
《赣南医学院学报》
2018年第12期1206-1209,共4页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
赣州市科技局指导性计划课题(编号:GZ2014ZSF103)
赣南医学院产学研课题(编号:CP201404)
关键词
小儿腹股沟疝
阑尾炎
肾积水
单孔腹腔镜手术
pediatric inguinal hernia
appendicitis
hydronephrosis
LESS
laparoscopic surgery
