Valla J, Ordorica-Flores R M, Steyaert H, Merrot T, Bartels A, Breaud J, Ginier C, Cheli M
Fondation Lenval for Children, 57, Avenue de la Californie, 06200 Nice, France.
Surg Endosc. 1999 Jan;13(1):83-5. doi: 10.1007/s004649900906.
To perform a laparoscopic appendectomy, three trocars are usually needed. In order to reduce abdominal wall trauma, we have adopted an umbilical one-puncture laparoscopic-assisted appendectomy (UOPLAA). We did a retrospective study of UOPLAA performed during last 2 years on 200 children aged from 5 to 18 years (median, 9 years). The patients were selected after clinical examination. No child with advanced generalized peritonitis or an abscess with a palpable mass was a candidate for this technique. UOPLAA was successful in 184 patients (92%). In 16 cases (8%), an additional trocar was required to manage perforated or retrocecal appendicitis. The mean operative time was 15 min, and the mean hospital stay was 2 days. There were no intraoperative complications. There were 10 (5%) postoperative complications (three parietal and seven intraabdominal). Four patients (2%) needed reoperation under general anesthesia. The UOPLAA is our preference in cases of acute nonperforated appendicitis because it is simple and fast, with good cosmetic results; but in 8% of our cases, an intraoperative difficulty (retrocecal location, abnormal adhesive band, peritonitis, etc.) arose that required the introduction of additional devices to ensure the safety of the laparoscopic procedure.
进行腹腔镜阑尾切除术通常需要三个套管针。为了减少腹壁创伤，我们采用了脐单孔腹腔镜辅助阑尾切除术（UOPLAA）。我们对过去两年中对200名年龄在5至18岁（中位数为9岁）的儿童进行的UOPLAA手术进行了回顾性研究。患者经过临床检查后入选。患有晚期全身性腹膜炎或可触及肿块的脓肿的儿童均不适合采用该技术。184例患者（92%）的UOPLAA手术成功。16例（8%）患者因处理穿孔性或盲肠后位阑尾炎需要额外的套管针。平均手术时间为15分钟，平均住院时间为2天。术中无并发症。术后有10例（5%）并发症（3例腹壁并发症和7例腹腔内并发症）。4例患者（2%）需要在全身麻醉下再次手术。UOPLAA是我们处理急性非穿孔性阑尾炎的首选方法，因为它简单快捷，美容效果好；但在我们8%的病例中，出现了术中困难（盲肠后位、异常粘连带、腹膜炎等），需要引入额外的器械以确保腹腔镜手术的安全。
