Alemayehu Hanna, Clifton Matthew, Santore Matthew, Diesen Diana, Kane Timothy, Petrosyan Mikael, Franklin Ashanti, Lal Dave, Ponsky Todd, Nalugo Margaret, Holcomb George W, St Peter Shawn D
1 The Children's Mercy Hospital , Kansas City, Missouri.
J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):243-7. doi: 10.1089/lap.2014.0288. Epub 2014 Dec 29.
The published experience with minimally invasive techniques to treat injured children is currently small. In this multicenter case series, we aimed to characterize the contemporary role of minimally invasive surgery (MIS) in pediatric trauma.
After obtaining Institutional Review Board approval at six pediatric regional trauma centers in the United States, a retrospective review was conducted on children who have undergone thoracoscopy or laparoscopy for the management of trauma over the past 13 years.
There were 200 patients with a mean age of 9.6 ± 4.2 years, and 73% were male. Laparoscopy was performed for 187 (94%) and thoracoscopy for 8 (4%), whereas 5 (2%) patients had both, for a total of 205 MIS procedures. Conversion to open surgery occurred in 36% (n=73). Median operative time was 77 (range, 16-369) minutes. Of the 132 procedures completed without conversion, 81 (61%) were diagnostic, whereas the remaining were therapeutic, including the repair of bowel injuries (n=20), distal pancreatectomy (n=5), splenectomy (n=2), repair of traumatic abdominal wall hernias (n=2), evacuation of hemothorax (n=3), and other thoracoscopic or laparoscopic interventions (n=19). Procedures that required conversion were most commonly for bowel injury (n=56). Patients with peritonitis were most likely to require conversion to an open procedure (77.4%). Mean time to a regular diet was 4.2 ± 8.6 days, and mean hospital stay was 6.3 ± 6.5 days. Postoperative complications occurred in 19 patients, long-term sequelae in 10 patients, and permanent disability in 2 patients. There were no deaths or missed injuries.
In the stable pediatric trauma patient, laparoscopy and thoracoscopy can be performed safely and effectively for both diagnostic and therapeutic purposes.
目前，已发表的关于采用微创技术治疗受伤儿童的经验有限。在这个多中心病例系列研究中，我们旨在明确微创手术（MIS）在小儿创伤治疗中的当代作用。
在美国六个小儿区域创伤中心获得机构审查委员会批准后，对过去13年中接受胸腔镜或腹腔镜检查以治疗创伤的儿童进行了回顾性研究。
共有200例患者，平均年龄为9.6±4.2岁，73%为男性。187例（94%）接受了腹腔镜检查，8例（4%）接受了胸腔镜检查，5例（2%）患者两者均接受了检查，总共进行了205例MIS手术。36%（n=73）的患者转为开放手术。中位手术时间为77（范围16 - 369）分钟。在132例未转为开放手术的手术中，81例（61%）为诊断性手术，其余为治疗性手术，包括肠损伤修复（n=20）、胰体尾切除术（n=5）、脾切除术（n=2）、创伤性腹壁疝修补术（n=2）、血胸引流（n=3）以及其他胸腔镜或腹腔镜干预（n=19）。需要转为开放手术的手术最常见的原因是肠损伤（n=56）。腹膜炎患者最有可能需要转为开放手术（77.4%）。恢复正常饮食的平均时间为4.2±8.6天，平均住院时间为6.3±6.5天。19例患者出现术后并发症，10例患者有长期后遗症，2例患者有永久性残疾。无死亡病例或漏诊损伤。
对于病情稳定的小儿创伤患者，腹腔镜检查和胸腔镜检查可安全有效地用于诊断和治疗目的。
