目的 总结儿童盲肠后位阑尾行腹腔镜切除的体会。方法 2019 年10 月～2024 年2 月，三孔法腹腔镜阑尾切除术中证实57 例盲肠后位阑尾炎。脐正中切口置入5 mm trocar和30°观察镜，下腹正中膀胱上、脐下3～5cm左侧腹直肌外缘分别置入5 mm trocar和操作钳，探查找到病变阑尾，结扎阑尾根部，电钩顺切和逆切相结合贴近阑尾离断阑尾头端和体部，若阑尾位于侧后腹膜外，需电钩打开侧后腹膜，显露、松解和离断阑尾。结果 57 例均获成功。手术时间65～120 min，(85。0±10。5)min。术后8～12h可自行下床活动，术后0。5～2d恢复排气并进流食，术后住院3～7d，平均5。5 d。随访1～18 个月，平均5。7 月，均无切口感染、粘连性肠梗阻、阑尾残株炎、盆腔脓肿等并发症发生。结论 盲肠后位阑尾与盲肠壁贴附紧密，手术时间相对较长。可先结扎阑尾根部，贴近阑尾壁离断阑尾，顺切和逆切阑尾相结合灵活操作。阑尾位于腹膜外时先电钩打开侧后腹膜显露阑尾，顺切和逆切相结合离断阑尾。
Laparoscopic Appendectomy in Children With Retrocecal Appendicitis:Report of 57 Cases
Objective To summarize the experience of laparoscopic appendectomy in children with retrocecal appendicitis.Methods Between October 2019 and February 2024,57 children with retrocecal appendicitis were confirmed in three-port laparoscopic appendectomy operations in this department.A 5 mm trocar and a 30°observation laparoscope were inserted through the umbilical midline incision.A 5 mm trocar and operating forceps were inserted through the midline above the bladder in the lower abdomen and the outer edge of the left rectus abdominis muscle 3-5 cm below the umbilicus,respectively.The laparoscopic forceps were inserted into the abdomen cavity to search and ligate the root of the appendix.An electric hook was used to detach the blind end and body of the appendix with combination of forward and reverse cutting.If the appendix was located outside of retroperitoneum,the electric hook was used to open retroperitoneum aiming to expose the appendix,followed by releasing,detaching and cutting the appendix.Results The operations were successfully completed in all the 57 cases.The operating time was 65-120 min(mean,85.0±10.5 min).All the patients got out of bed and moved around at 8-12 h after surgery and passed flatus and took liquid diet at 0.5-2 d after surgery.The postoperative hospital stay was 3-7 d(mean,5.5 d).The follow-ups time ranged from 1 to 18 months(mean,5.7 months).No complications were noted,including wound infection,adhesive intestinal obstruction,appendiceal stump inflammation or pelvic abscess.Conclusions The retrocecal appendix is closely attached to the cecal wall,leading to a relatively long surgical time.During the operation,the root of the appendix should be ligated firstly,and the appendix be detached closely to the appendix wall.The combination of forward and backward appendectomy during the surgery should be emphasized.In case the appendix is located outside of the retroperitoneum,the lateral retroperitoneum should be opened with an electric hook to expose the appendix,and the appendix should be removed by combining forward and reverse cutting.
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