Indiana University, Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN.
Indiana University, Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN.
J Pediatr Surg. 2020 Oct;55(10):2094-2098. doi: 10.1016/j.jpedsurg.2020.01.055. Epub 2020 Feb 13.
Laparoscopy is commonplace in pediatric surgery. Abdominal access via the umbilicus may present a unique challenge in neonates and young infants predisposing them to complications. We hypothesized that these complications may occur more than described in the literature.
Members of the American Pediatric Surgical Association (APSA) were anonymously surveyed in February of 2018 via REDCap™ regarding technique of umbilical access in infants less than 3 months of age and complications experienced during umbilical access. Approval was obtained from the IRB and the APSA Outcomes and Evidence-based Practice Committee.
The response rate was 31.3% (329/1050). 62.3% of respondents performed 21 or greater neonatal laparoscopic procedures annually. 34 of 322 respondents reported a direct complication from umbilical access for laparoscopy in this age group (10.6%). Surgeons described 37 specific cases with complications related to umbilical access, with laparoscopic pyloromyotomy making up 47.2% (17/36). CO embolism was the most common complication; 15.4% of surgeons reported not knowing about the possibility of CO embolism. 41% of surgeons confirm intraabdominal placement of the umbilical trocar prior to insufflation. There was no association between any complication and where the umbilical trocar was placed (above/below/through umbilicus) or placement technique in patients with no umbilical cord stump. There may be an association between complication and where the umbilicus is entered in patients with an umbilical cord stump still in place (p = 0.013).
Umbilical access for laparoscopy in neonates and infants less than 3 months of age can present a unique challenge and result in significant complications. All techniques and methods had complications. Surgeons should be aware of these risks and be prepared to manage them emergently if they arise.
V, expert opinion.
腹腔镜检查在小儿外科中很常见。通过脐部进行腹部进入可能会给新生儿和婴儿带来独特的挑战，使他们容易发生并发症。我们假设这些并发症的发生可能比文献中描述的更为常见。
2018 年 2 月，美国小儿外科学会（APSA）成员通过 REDCap™接受了一项匿名调查，内容涉及 3 个月以下婴儿脐部进入的技术以及脐部进入过程中出现的并发症。该研究获得了机构审查委员会和 APSA 结果与循证实践委员会的批准。
应答率为 31.3%（329/1050）。62.3%的受访者每年进行 21 次或更多的新生儿腹腔镜手术。322 名受访者中有 34 名（10.6%）报告在该年龄段的腹腔镜手术中直接出现脐部进入相关并发症。外科医生描述了 37 例与脐部进入相关的并发症具体病例，其中腹腔镜幽门肌切开术占 47.2%（17/36）。CO 栓塞是最常见的并发症；15.4%的外科医生表示不知道 CO 栓塞的可能性。41%的外科医生在充气前确认脐部套管针位于腹腔内。在没有脐带残端的患者中，套管针的放置位置（脐上/脐下/经脐）或放置技术与任何并发症之间没有关联。在有脐带残端的患者中，脐部进入的位置与并发症之间可能存在关联（p=0.013）。
对于 3 个月以下的新生儿和婴儿，腹腔镜脐部进入可能会带来独特的挑战，并导致严重的并发症。所有的技术和方法都有并发症。外科医生应该意识到这些风险，并准备在出现并发症时紧急处理。
V，专家意见。
