探讨腹腔镜技术应用于儿童腹腔涉及重要血管的淋巴管瘤处理。

回顾性分析2003～2020年河北医科大学第二医院小儿外科收治的涉及重要血管的腹内淋巴管瘤22例患儿的临床资料、手术处理策略、手术时间、术后复发率和并发症等情况。

其中18例完全腹腔镜淋巴管瘤切除获得成功，4例累及肠管巨大病变，延长脐部切口后，牵出腹外连同肠管一并切除。其中涉及重要血管包括脾血管3例、腹膜后大血管5例、肠系膜血管14例。手术时间50～270 min，平均(131.40±35.2)min；术中出血量1～300 ml，平均(41.84±5.24)ml；术后恢复排气、排便时间平均3.45 d；术后住院时间6～38 d，平均(15.54±2.36)d；无切口感染，术后病理均回报淋巴管瘤。2例术后引流液每日100～200 ml，考虑淋巴管漏，经引流后治愈；2例术后超声提示少量腹水，经1～3个月随诊消失。所有患儿均无复发、粘连性肠梗阻发生。

腹腔镜手术是一种安全、可行的方法，患儿术后恢复快，切口瘢痕小、美观，尤其对于涉及重要血管的腹部淋巴管瘤切除，创伤小，手术视野显露好，裸化血管安全性高。

To explore the application of laparoscopic technique in the treatment of lymphangioma involving important blood vessels in the abdominal cavity of children.

A retrospective analysis of the clinical data, surgical treatment strategies, surgical time, postoperative recurrence rate and complications of 22 children with intra-abdominal lymphangioma involving important blood vessels admitted to the Pediatric Surgery Department of the Second Hospital of Hebei Medical University from 2003 to 2020.

Among them, 18 cases of complete laparoscopic lymphangioma resection were successful, and 4 cases involved huge intestinal lesions. After lengthening the umbilical incision, the abdomen was removed together with the intestinal tube. The important blood vessels involved included 3 cases of splenic blood vessels, 5 cases of retroperitoneal large blood vessels, and 14 cases of mesenteric blood vessels. The operation time is 50-270 min, (131.40±35.2) min, the intraoperative blood volume is 1-300 ml, (41.84±5.24)ml, the average postoperative recovery time is 3.45 days, and the postoperative hospital stay is 6 to 38 days, (15.54±2.36) days, no incision infection, postoperative pathology reported lymphangioma. 2 cases of postoperative drainage fluid 100-200 ml per day, considering the leakage of lymphatic vessels, were cured after drainage; 2 cases of postoperative B-ultrasound showed a small amount of abdominal effusion, which disappeared after 1 to 3 months follow-up. All children had no recurrence or adhesive intestinal obstruction.

Laparoscopic surgery is a safe and feasible method. The child recovers quickly after surgery. The incision scar is small and beautiful. Especially for the resection of abdominal lymphangioma involving important blood vessels, it has less trauma, good visual field exposure, and safe naked blood vessels.