Peters C A
Department of Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 1996 Mar;155(3):1070-3.
To assess the level of activity in pediatric urological laparoscopy and its relationship to complications a survey of the membership of the American Academy of Pediatrics, Section on Urology was conducted.
An anonymous questionnaire was mailed to 251 pediatric urologists and 153 responses were recorded.
Of the respondents 75% reported performing diagnostic and operative laparoscopy (average 54 cases). Patient age ranged from newborn to 20 years. Average case load for laparoscopy was 19 of 401 total cases yearly. More than 5,400 laparoscopic cases are represented by the reported experience. Complications were reported in 5.38% of cases (average complication rate 6.06% per practitioner). Excluding preperitoneal insufflation or subcutaneous emphysema the complication rate was 1.18%. Complications requiring surgical repair occurred in 0.39% of cases, including bowel, bladder and great vessel injury. The clearest predictor of complication rate was laparoscopic experience. The technique used to obtain pneumoperitoneum was also important in that Veress needle technique was associated with a 2.6% significant complication rate in contrast to 1.2% for open technique (p < 0.006).
Laparoscopy is widely practiced in the pediatric urological community with a good safety record. Complications occur and important means of minimizing them are to provide for supervised experience with emphasis on the details of safe technique.
为评估小儿泌尿外科腹腔镜手术的开展水平及其与并发症的关系，对美国儿科学会泌尿外科分会的成员进行了一项调查。
向251名小儿泌尿外科医生邮寄了一份匿名问卷，共收到153份回复。
75%的受访者报告开展了诊断性和手术性腹腔镜手术（平均54例）。患者年龄从新生儿到20岁不等。腹腔镜手术的平均年病例数为401例中的19例。报告的经验涵盖了超过5400例腹腔镜手术病例。5.38%的病例报告有并发症（每位医生的平均并发症发生率为6.06%）。排除腹膜前气腹或皮下气肿后，并发症发生率为1.18%。需要手术修复的并发症发生率为0.39%，包括肠道、膀胱和大血管损伤。并发症发生率最明确的预测因素是腹腔镜手术经验。建立气腹的技术也很重要，因为Veress针技术的显著并发症发生率为2.6%，而开放技术为1.2%（p<0.006）。
腹腔镜手术在小儿泌尿外科领域广泛应用，安全性良好。并发症会发生，将其降至最低的重要方法是提供有监督的经验，重点是安全技术细节。
