Golebiewski Andrzej, Czauderna Piotr
Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):101-6. doi: 10.5114/wiitm.2014.47510. Epub 2014 Dec 4.
Despite the increase in use of laparoscopic appendectomy (LA) in recent years, until now no nationwide survey on this issue has been performed in Poland.
To determine current surgical practice patterns among Polish pediatric surgeons in the treatment of appendicitis in children.
The nationwide survey was conducted in the form of an internet questionnaire asking for information concerning treatment of children suspected of having acute appendicitis in the years 2007-2011. Twenty-seven major pediatric surgical departments in Poland were invited to participate in the study.
The overall survey response rate was 70.37%. Laparoscopic appendectomy was offered in all departments except one. Laparoscopy was used in 33% of cases and was the standard procedure in 4 departments. In 1 center 100% of appendectomies were performed laparoscopically. The 3-port technique was used in all departments. Five centers offered transumbilical laparoscopic extracorporeal appendectomy and 2 centers single-port appendectomy. In LA the mesoappendix was mostly divided using bipolar or monopolar coagulation and the appendix was ligated using endoloops or was clipped. The mean hospitalization time was 3.31 days after laparoscopy and 5.47 days after open appendectomy.
Despite an apparent consensus on some aspects of pediatric appendicitis among Polish pediatric surgeons, significant inconsistency exists in the operative approach. The low rate of LA suggests that LA still remains far from being a standard. Personal experience and preference have a major influence on the choice of operative approach. It is recommended that national guidelines be set up, which could standardize the care for children and training of pediatric surgery residents.
尽管近年来腹腔镜阑尾切除术（LA）的使用有所增加，但迄今为止波兰尚未就这一问题进行全国性调查。
确定波兰小儿外科医生在儿童阑尾炎治疗方面当前的手术实践模式。
全国性调查以网络问卷的形式进行，询问有关2007 - 2011年疑似患有急性阑尾炎儿童的治疗信息。邀请了波兰27个主要的小儿外科科室参与研究。
总体调查回复率为70.37%。除一个科室外，所有科室都提供腹腔镜阑尾切除术。33%的病例采用了腹腔镜手术，4个科室将其作为标准手术方式。在1个中心，100%的阑尾切除术是通过腹腔镜进行的。所有科室均采用三孔技术。5个中心提供经脐腹腔镜体外阑尾切除术，2个中心提供单孔阑尾切除术。在腹腔镜阑尾切除术中，阑尾系膜大多使用双极或单极电凝进行分离，阑尾使用圈套器结扎或夹闭。腹腔镜手术后平均住院时间为3.31天，开腹阑尾切除术后为5.47天。
尽管波兰小儿外科医生在小儿阑尾炎的某些方面似乎已达成共识，但手术方式仍存在显著差异。腹腔镜阑尾切除术的低使用率表明其仍远未成为标准术式。个人经验和偏好对手术方式的选择有重大影响。建议制定国家指南，以规范儿童护理及小儿外科住院医师培训。
