Lai Sarah W, Rothenberg Steven S, Shipman Kristin E, Kay Saundra M, Slater Bethany J
1 Alberta Children's Hospital , Calgary, Alberta, Canada .
2 Rocky Mountain Pediatric Surgery, Rocky Mountain Hospital for Children , Denver, Colorado.
J Laparoendosc Adv Surg Tech A. 2017 Mar;27(3):306-310. doi: 10.1089/lap.2016.0221. Epub 2017 Jan 13.
To evaluate two-incision laparoscopic cholecystectomy (2I-LC) in children, and compare outcomes with four-port laparoscopic cholecystectomy (4P-LC).
A retrospective review was performed on children (≤21 years) with gallbladder disease treated with 2I-LC or 4P-LC between February 2010 and February 2016. 2I-LC is performed using two 5-mm ports and a 2-mm endoscopic grasper within a 12-mm umbilical incision, and a 3-mm subxiphoid port for dissection. Demographic, diagnostic, operative, and outcome data were recorded, and the two groups were compared with chi-squared, Fisher, and t-tests. Patients requiring conversion from 2I-LC to 4P-LC were examined to determine factors predicting the need for additional ports.
Three hundred eighty-nine laparoscopic cholecystectomies were performed (2I-LC 72.0%, 4P-LC 19.0%). Body mass index (BMI) was greater in the 4P-LC group. 2I-LC was more commonly performed for biliary dyskinesia, but not biliary colic, acute cholecystitis, choledocholithiasis, and gallstone pancreatitis. Operative time was greater in 4P-LC. There were 6 wound infections (2I-LC 1.8%, 4P-LC 1.5%), 1 common bile duct injury (2I-LC 0.4%, 4P-LC 0.0%), and 1 small bowel injury (2I-LC 0.0%, 4P-LC 1.5%). 2.4% of 2I-LC required conversion to 4P-LC, with BMI and operative time greater than the 2I-LC group, but not different from 4P-LC with no complications.
2I-LC is a safe alternative to 4P-LC for pediatric gallbladder disease, allowing for traction and countertraction to expose the critical view. Operative time was longer in the 4P-LC group, likely secondary to selection bias with higher BMI and preoperative diagnosis of gallstone disease. Overweight patients are more likely to require additional ports.
评估两孔法腹腔镜胆囊切除术（2I-LC）在儿童中的应用，并与四孔法腹腔镜胆囊切除术（4P-LC）的手术结果进行比较。
对2010年2月至2016年2月期间接受2I-LC或4P-LC治疗的胆囊疾病患儿（≤21岁）进行回顾性研究。2I-LC通过在12mm脐部切口内使用两个5mm端口和一个2mm内镜抓钳以及一个3mm剑突下端口进行解剖来实施。记录人口统计学、诊断、手术和结果数据，并通过卡方检验、Fisher检验和t检验对两组进行比较。对需要从2I-LC转换为4P-LC的患者进行检查，以确定预测需要额外端口的因素。
共进行了389例腹腔镜胆囊切除术（2I-LC占72.0%，4P-LC占19.0%）。4P-LC组的体重指数（BMI）更高。2I-LC更常用于治疗胆囊运动障碍，但不用于治疗胆绞痛、急性胆囊炎、胆总管结石和胆石性胰腺炎。4P-LC的手术时间更长。有6例伤口感染（2I-LC占1.8%，4P-LC占1.5%），1例胆总管损伤（2I-LC占0.4%，4P-LC占0.0%），1例小肠损伤（2I-LC占0.0%，4P-LC占1.5%）。2.4%的2I-LC需要转换为4P-LC，其BMI和手术时间均高于2I-LC组，但与无并发症的4P-LC组无差异。
对于儿童胆囊疾病，2I-LC是4P-LC的一种安全替代方法，可通过牵引和对抗牵引来暴露关键视野。4P-LC组的手术时间更长，可能是由于BMI较高和术前诊断为胆石症导致的选择偏倚。超重患者更有可能需要额外的端口。
