Sesia Sergio B, Haecker Frank-Martin, Kubiak Rainer, Mayr Johannes
Department of Paediatric Surgery, University Children's Hospital Basle (UKBB), Basle, Switzerland.
J Laparoendosc Adv Surg Tech A. 2010 Dec;20(10):867-71. doi: 10.1089/lap.2010.0180. Epub 2010 Sep 29.
In childhood, laparoscopy-assisted single-port appendectomy (SPA), including the advantages of open and laparoscopic surgery, is not widely used. However, there is debate whether the retrieval of the infected appendix via the umbilicus results in a higher infection rate compared with other laparoscopic or open techniques. The aim of the study was to determine the postoperative infection rate and possible risk factors for infection after SPA in children.
For this retrospective study, case notes of all children (n = 262) who underwent SPA between August 2005 and December 2008 were reviewed. Those children in whom the preoperative ultrasonography revealed suspected perforation were excluded from SPA and subsequently underwent open surgery. SPA was performed using a 12-mm trocar with one 5-mm working channel, introduced through a sub-umbilical incision. After grasping the appendix with atraumatic forceps, the appendix was exteriorized through the umbilicus and dissected outside the abdominal cavity as in open surgery. Preoperatively, each patient received one dose of Metronidazole and Cefuroxime, and the umbilicus was cleaned in particular.
Of the 262 children who underwent SPA, 146 were boys (55.7%) and 116 girls (44.3%). Median age at operation was 11.4 years (range, 1.1-15.9). Six obese (with a body mass index greater than the 95th percentile) children (2.3%) developed intra-abdominal abscess after perforated appendicitis that was treated with a course of antibiotics. One child required revisional surgery and drainage. The median length of antibiotic treatment was 3 days (range, 0-15).
In our institution, SPA is the method of choice for appendectomy in children with acute appendicitis, in whom preoperative ultrasound does not reveal signs of perforation. The infection rate (2.7%) after SPA is not increased compared with other laparoscopic or open techniques. Overweight (body mass index greater than the 95th percentile) and perforated appendicitis seem to increase the risk of postoperative infectious complications.
在儿童中，腹腔镜辅助单孔阑尾切除术（SPA）兼具开放手术和腹腔镜手术的优点，但尚未得到广泛应用。然而，经脐部取出感染性阑尾与其他腹腔镜或开放手术技术相比，是否会导致更高的感染率仍存在争议。本研究的目的是确定儿童SPA术后的感染率及可能的感染危险因素。
对于这项回顾性研究，我们查阅了2005年8月至2008年12月期间所有接受SPA的儿童（n = 262）的病历。术前超声检查显示疑似穿孔的儿童被排除在SPA之外，随后接受开放手术。SPA通过一个12毫米的套管针和一个5毫米的工作通道进行，经脐下切口置入。用无损伤钳夹住阑尾后，将阑尾经脐部引出，并像开放手术一样在腹腔外进行解剖。术前，每位患者接受一剂甲硝唑和头孢呋辛，并特别清洁脐部。
在262例接受SPA的儿童中，146例为男孩（55.7%），116例为女孩（44.3%）。手术时的中位年龄为11.4岁（范围为1.1 - 15.9岁）。6例肥胖（体重指数大于第95百分位数）儿童（2.3%）在阑尾穿孔后发生腹腔内脓肿，接受了一个疗程的抗生素治疗。1例儿童需要再次手术和引流。抗生素治疗的中位时长为3天（范围为0 - 15天）。
在我们机构，对于术前超声未显示穿孔迹象的急性阑尾炎儿童，SPA是阑尾切除术的首选方法。与其他腹腔镜或开放手术技术相比，SPA后的感染率（2.7%）并未增加。超重（体重指数大于第95百分位数）和阑尾穿孔似乎会增加术后感染并发症的风险。
