Results and complications of laparoscopic cholecystectomy in childhood
Results and complications of laparoscopic cholecystectomy in childhood
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DOI：
10.1007/s004640000042
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发表时间：
2001-08-01
期刊：
影响因子：
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通讯作者：
Settimi, A
中科院分区：
文献类型：
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作者：
Esposito, C;Sabin, MAG;Settimi, A
背景：我们研究的目的是评估110例婴儿腹腔镜胆囊切除术的结果和并发症。方法：在5年的时间里（1993- 1998），我们对110例儿童患者进行了腹腔镜胆囊切除术。手术由三个不同的医生在三个不同的机构进行。患者群体由69名女孩和41名男孩组成；他们的年龄从1岁到16岁不等（中位数8.5岁）。110例患儿均有症状性胆石症，经超声检查证实。27例患者出现相关病理（镰状细胞病17例，遗传性球形细胞增多症7例，地中海贫血3例）；其余83例患儿为特发性胆石症。107例患者使用4个端口进行手术；在三名患者中，使用了五个端口。在3例患者中，我们同时进行了脾切除术。结果：单纯性胆囊切除术的中位持续时间为45分钟（范围25-75），住院时间为1 - 10天（中位2天）。只有15名儿童需要引流。在我们的研究中有17例并发症（15.5%），包括11例患者在剥离过程中胆囊穿孔，1例患者在取出过程中结石落入腹腔，5例患者术后套管针口感染。最长随访5年（范围1-5年），所有患者均表现良好。结论：儿童有症状的胆石症行腹腔镜胆囊切除术与开腹手术一样有效。与成人相比，儿科患者更需要精确的解剖和对可能的先天性胆道异常的充分了解，以避免任何并发症。
Background: The purpose of our study was to evaluate the results and complications of laparoscopic cholecystectomy in a case series of 110 infants.Methods: Over a 5-year period (1993-98), we performed laparoscopic cholecystectomy in 110 pediatric patients. Surgery was performed at three different institutions by three different surgeons. The patient population was composed of 69 girls and 41 boys; their ages ranged from 1 to 16 years (median, 8.5). All of the 110 children had symptomatic cholelithiasis, which was confirmed at ultrasound examination. An associated pathology was present in 27 patients (sickle cell disease in 17 cases, hereditary spherocytosis in seven cases, thalassemia in three); the other 83 infants were affected by idiopathic cholelithiasis. In 107 patients, the operation was performed using four ports; in three patients, it was done using five ports. In three patients, we also performed a concomitant splenectomy.Results: Median duration of simple cholecystectomy was 45 min (range, 25-75) and hospital stay ranged from 1 to 10 days (median, 2). Only 15 children required drainage. We had 17 complications in our series (15.5%), including a gallbladder perforation during dissection in 11 patients, a fall of stones into the abdominal cavity during extraction in one patient, and a trocar orifice infection in the postoperative period in five patients. At a maximum follow-up of five years (range, 1-5), all patients were doing well.Conclusion: Laparoscopic cholecystectomy in children seems to be as effective as open surgery in cases of symptomatic cholelithiasis. In pediatric patients more than in adults, an accurate and precise dissection and a sound knowledge of possible congenital biliary abnormalities are essential to avoid any kind of complication.