Chan Kin Wai, Lee K H, Tam Y H, Yeung C K
Division of Paediatric Surgery & Paediatric Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
J Laparoendosc Adv Surg Tech A. 2007 Dec;17(6):817-20. doi: 10.1089/lap.2007.0033.
There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors.
A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005.
Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results.
With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.
在小儿实体肿瘤切除术中使用微创手术（MIS）技术的经验有限。在本文中，我们报告了使用MIS技术治疗小儿实体肿瘤的经验。
对1995年至2005年间所有接受MIS治疗实体肿瘤的儿童进行回顾性研究。
在10年期间，有38例患者接受了MIS肿瘤切除术。手术时的平均年龄为7.5岁（范围为1天至15岁）。其中有22例卵巢肿瘤、4例骶尾部肿瘤、3例肾上腺肿瘤、3例腹膜后肿瘤、1例肾肿瘤、1例肝脏肿物、1例腹腔内睾丸肿瘤和3例胸腔肿物。38例患者中有30例（78.9%）使用MIS技术成功切除肿瘤。8例患者因7例腹腔空间有限和1例出血过多而转为开放手术。在28例成功通过MIS切除的腹腔肿瘤中，18例需要扩大脐部切口，5例需要额外的耻骨上横切口以取出肿瘤。2例成功通过MIS切除的胸腔肿物需要扩大胸腔切口以取出标本。平均手术时间为171分钟（范围为45 - 275分钟）。未出现术后并发症。平均随访3.1年，未观察到复发，即使是7例恶性肿瘤患者，所有成功通过MIS切除肿瘤的患者美容效果良好。
随着腹腔镜器械和技术的进步，多种小儿实体肿瘤可通过MIS技术安全切除。这可能带来术后恢复更快和美容效果更好的潜在益处。MIS技术在切除恶性肿瘤中的作用尚不确定，因为本系列病例数量太少，无法得出任何结论。
