Application Of Laparoscopic Technique In The Treatment Process Of Children With Acute Abdomen

Objective:To research the application and advantages of laparoscopic technique in the treatmentprocess of children with acute abdomen.Methods:The children with acute abdomen（acute appendicitis，meckel diverticulitis，ovariantorsion,acute intussusception,intestinal duplication,congenital malrotation ofintestine,incarcerated hernia,gastrointestinal perforation）were selected as objects of thestudy between March2010and March2013in our hospital. And with the clinical datawere collected respectively including clinical manifestations of admission,laboratorytests,imaging data,the operational choice of time and method,as well as the number of thepatients, length of opertion,postoperative recovery,hospitalization and follow-up databetween laparoscopic surgery(LS) and open surgery(OS).The information ofindications,precedures,advantages and disadvantages of laparoscopic surgery wereanylized and evaluated.Results：Results:1,102cases were selected in our hospital of children with acute abdomen inthis study,including540cases（49.0%）of acute appendicitis,250cases（22.7%）ofintussusception,115cases（10.4%）of incarcerated hernia，60cases（5.4%）of ovarianteratoma,46case（s4.2%）of congenital malrotation of intestine，37case（s3.4%）of Meckel,sdiverticulum，32cases（2.9%）of gastrointestinal perforation，22cases（2.0%）of intestinalduplication. Among all of acute abdomen,the group LS is superior to the group OS(p<0.05)in the aspects of blood loss,the length of intestinal function recovery time,hospital stay.In540cases of acute appendicitis,234cases were treated by laparoscopy,and6cases wereturned to laparotomy,300cases were treated by laparotomy.The length of operation timehas no difference between LS （55.62.13±25.36min） and OS （65.24±30.15min）(P>0.05).The group LS,postoperative wound infection were found in4cases(1.7%),and 13cases（4.3%）in group OS.In250cases of intussusception,5cases were treated bylaparoscopy,and2cases were treated under the help of laparoscopy because of intestinaltumor,1case of cecal duplication and1case of lleocecal intussusception were turned tolaparotomy, and the rest (241cases) were treated by laparotomy, among them.The length ofoperation time has significant difference between LS （50.42±7.31min） and OS（90.15±20.29min）(P<0.05).In the group LS,postoperative wound infection wereunfound,and5cases（2.1%）in group OS.In37cases of Meckel,s diverticulum,16caseswere treated under the help of laparoscopy,among them3were turned to laparotomybecause of diverticular perforation and adhesion severely,5cases with suspected diagnoisbefore operation were identified and treated with the laparoscopy, the other18cases weretreated by laparotomy..As the same result, The length of operation time has significantdifference between LS（68.45±28.15min） and OS（116.27±31.23min）(P<0.05).in Thegroup LS,postoperative wound infection were unfound,and1cases（5.6%）in group OS.2cases of18cases were diagnosed with incomplete intestinal obstruction and improvedafter conservative treatment in group OS.In22cases of intestinal duplication,11cases weretreated under the help of laparoscopy, with2turned to laparotomy because of big cysts andlleocecal intussusception were,9cases were treated by laparotomy.The length of operationtime has significant difference between LS （84.16±15.62min） and OS（131.66±35.30min）(P<0.05).Wound infection were unfound in both groups.In46casesof congenital malrotation of intestine,13cases were treated under the help oflaparoscopy,with2cases turned to laparotomy because of annular pancreas and volvuluswith narrow operation space,and31cases were treated by laparotomy.4cases in LP groupcombined with other malformations which were found during opereation.The length ofoperation time has difference between LS（118.46±31.98min）and OS（76.29±25.75min）(P<0.05),LS group were significantly longer than OS.In60cases of ovarian teratoma,30cases were treated under the help of laparoscopy,with4cases were turned to laparotomydue to big cysts and excessive bleeding.the rest26cases were treated bylaparotomy.Furthermore,4cases in LP group were found with inguinal hernia and werecured.The length of operation time has difference between LS（80.14±26.13min） andOS（87.6±32.25min）(P<0.05).Wound infection were unfound in both groups.In115casesof incarcerated hernia,9cases were treated under the help of laparoscopy,1case wasturned to laparotomy,2cases in LS group was found with hidden hernia in the contralateral and under went a sugincal management.in the group of OS,3cases had a recurrence, and15cases was found with hernia in the contralateral.The length of operation time hasdifference between LS（40.81±20.43min） and OS（91.52±30.57min）(P<0.05).Woundinfection were unfound in group LS and4cases（5.6%）in group OS.In32cases ofgastrointestinal perforation,15cases were neonatal necrotizing enterocolitis(NEC),7caseswere congenital defects of gastric musculature,2cases of NEC which secondary tomegacolon,1case of anal atresia,1case of choledochocyst,2cases of intestinal atresia(1case of sigmoid atresia and1case of lleal atresia),2cases of delayed intestinalperforation(after the operation of incarcerated indirect inguinal),2cases caused bytrauma,and1case was treated under the help of laparoscopy and recovered well. All therest were trerted by OS.Conclusion:1．Laparoscopy is safety and feasible applied in theatment of pediatric acuteabdomen, and the cause could be identified in help of laparoscopy during operation.2．There were Obvious advantages of Laparoscopy over open surgery in thetreatment of pediatric acute appendicitis, ovarian torsion, Meckel diverticulum, intestinalduplication. However, in the treatment of Acute intussusception and incarcerated inguinalhernia, Laparoscopy has a relatively low success rate. Instead, in terms of identifyinggastrointestinal perforation site and incision selection, Laparoscopy shows advantagestoo. For the treatment of pediatric intestinal malrotation, the use of Laparoscopy should befurther evaluated.3．Mean while, Laparoscopy is a useful way to find some recessive disease duringoperation and make appropriate treatment correspondingly.