Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
World J Surg. 2012 Aug;36(8):1958-62. doi: 10.1007/s00268-012-1585-1.
Several studies have demonstrated that laparoscopic surgery is safe and effective for urgent and emergent colectomy in adulthood. The aim of the present study was to evaluate the feasibility of laparoscopic colectomy for children in emergent settings.
Between March 2008 and August 2011, 10 consecutive children with acute colonic perforations and fibropurulent peritonitis secondary to infectious colitis underwent emergency laparoscopic colectomy. Simultaneously, we reviewed and recorded the same data from another consecutive 10 patients who underwent standard laparotomy between November 2004 and February 2008. The two groups were compared with regard to operative time, length of hospital stay (LOS), and complications.
The gender, age, body weight, serum C-reactive protein, number of involved bowel segments, operative time, and LOS were not significantly different (P = 0.36, 0.50, 0.33, 0.62, 0.81, 0.14 and 0.23, respectively). In the laparoscopy group, one patient required conversion to open surgery because of extensive bowel involvement, and another patient with solitary colonic perforation required reoperation for anastomostic leakage. However, patients who underwent laparotomy had a higher incidence of later complications, including wound infection, incisional hernia, and adhesion ileus (P = 0.03, 0.06, and 0.03, respectively) and thus required more additional unplanned operations (P = 0.05).
Emergency laparoscopic surgery is technically feasible in most children with acute colonic perforations and fibropurulent peritonitis. However, extensive intestinal involvement with multiple perforations should be an indication for converting to open surgery.
多项研究已证实，腹腔镜手术对于成人的紧急和急诊结肠切除术是安全且有效的。本研究旨在评估在紧急情况下对儿童进行腹腔镜结肠切除术的可行性。
2008 年 3 月至 2011 年 8 月期间，10 例因感染性结肠炎导致急性结肠穿孔和纤维脓性腹膜炎的儿童连续接受了紧急腹腔镜结肠切除术。同时，我们回顾并记录了 2004 年 11 月至 2008 年 2 月期间连续 10 例行标准剖腹手术的患者的相同数据。比较两组患者的手术时间、住院时间（LOS）和并发症。
性别、年龄、体重、血清 C 反应蛋白、受累肠段数、手术时间和 LOS 无显著差异（P = 0.36、0.50、0.33、0.62、0.81、0.14 和 0.23）。在腹腔镜组中，1 例患者因广泛肠受累而需要转为开腹手术，另 1 例单发结肠穿孔患者因吻合口漏需要再次手术。然而，行剖腹手术的患者发生后期并发症的风险更高，包括伤口感染、切口疝和粘连性肠梗阻（P = 0.03、0.06 和 0.03），因此需要更多的非计划手术（P = 0.05）。
对于大多数患有急性结肠穿孔和纤维脓性腹膜炎的儿童，紧急腹腔镜手术在技术上是可行的。然而，广泛的肠受累和多处穿孔应是转为开腹手术的指征。
