Binet Aurelian, Braïk Karim, Lengelle Francois, Laffon Marc, Lardy Hubert, Amar Sarah
Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
J Pediatr Surg. 2018 Nov;53(11):2322-2325. doi: 10.1016/j.jpedsurg.2017.12.018. Epub 2017 Dec 27.
Appendectomy is a well-established surgical procedure in pediatric surgery used in the management of acute appendicitis. With the continuous advancement in the field of minimal invasive surgery, the recent focus is on single incision laparoscopic (SIL) surgery. SILA also goes further in order to decrease pain, improve recovery and enhance patient satisfaction. However, this approach is still not a well-established technique and not widely practiced, especially in pediatric surgery.
We prospectively recorded the data in our pediatric universitary hospital center since January, 01 2017 to July, 01 2017. Patients included in this study were randomized in two groups: SILA group (managed by one-port laparoscopy, n=40) and LA group (conventional laparoscopy using three trocars, n=40).
The mean operative time for SILA was significantly lower. There were no postoperative complications in SILA group. If peritonitis was associated with appendicitis, the operative duration was not significantly different between each group. The duration in recovery room after surgery was significantly lower in SILA group. The morphine consumption was significantly lower for SILA group according to patient weight. SILA is less painful significantly than CLA for the first postoperative 6 h. After, even if SILA appears less painful, difference is not significant. The hospital length of stay was significantly higher in LA than SILA group CONCLUSIONS: SILA procedure for appendectomy appears to be safe and efficient for appendicitis management in children. This technique could be applied in routine as in emergency tome.
Prospective comparative study LEVEL OF EVIDENCE: II.
阑尾切除术是小儿外科中用于治疗急性阑尾炎的成熟手术方法。随着微创手术领域的不断发展，近期的重点是单切口腹腔镜（SIL）手术。单切口腹腔镜阑尾切除术（SILA）更是为了减轻疼痛、促进恢复并提高患者满意度而进一步发展。然而，这种方法仍不是一种成熟的技术，尚未广泛应用，尤其是在小儿外科领域。
自2017年1月1日至2017年7月1日，我们在儿科大学医院中心前瞻性地记录了数据。本研究纳入的患者被随机分为两组：SILA组（通过单孔腹腔镜手术治疗，n = 40）和LA组（使用三个套管针的传统腹腔镜手术，n = 40）。
SILA组的平均手术时间明显更短。SILA组无术后并发症。如果阑尾炎伴有腹膜炎，每组之间的手术持续时间无显著差异。SILA组术后在恢复室的停留时间明显更短。根据患者体重，SILA组的吗啡消耗量明显更低。术后第1个6小时内，SILA组的疼痛明显比传统腹腔镜阑尾切除术（CLA）轻。之后，即使SILA组似乎疼痛较轻，但差异不显著。LA组的住院时间明显长于SILA组。结论：SILA阑尾切除手术在儿童阑尾炎治疗中似乎是安全有效的。这种技术可在常规及急诊情况下应用。
前瞻性对比研究 证据级别：II级
