KH Lee, CK Yeung

Abstract

Development of laparoscopic or minimally invasive surgery (MIS) in infants and children has taken a tremendous pace over the past decade. With the availability of appropriately sized fine instruments tailored made for small paediatric patients, together with significant improvement in surgical technique and anaesthetic experience, a wide range of operations can now be performed by the laparoscopic approach even in small newborn infants. These include a whole spectrum of gastrointestinal tract operations, herniotomy and even more complicated thoracoscopic and laparoscopic reconstructive procedures, e.g. oesophageal anastomosis for oesophageal atresia and surgery for choledochal cyst and biliary atresia. Evidence so far suggests that minimal access surgery results in a more rapid recovery, shorter hospital stay and much better wound cosmesis. The advent of MIS has revolutionised the overall management strategy for certain diseases such as Hirschsprung's disease, imperforate anus and gastro-oesophageal reflux. There is no age limit to its application. With further improvement in technology and advances in surgical experience and skills, there is little doubt that laparoscopic surgery would gain a much wider acceptance and become the treatment of choice in place of conventional open surgery for the great majority of surgical conditions in infants and young children in this new millennium.

過去十年，腹腔鏡或微創手術在嬰幼兒中的應用已取得巨大的進展。隨著適合小兒的精細腹腔鏡手術儀器的出現，以及外科技術和麻醉經驗的顯著提高，現今許多小兒外科手術已可通過腹腔鏡進行，甚至剛出生的嬰兒也可施行。其中應用包括腸道胃手術，疝修補術等等，甚至許多複雜的胸腔及腹腔的重建手術。例如食道閉鎖食道吻合術及膽總管囊腫和膽道閉鎖的外科手術。醫學證據顯示微創手術可令病人更快康復，縮短住院時間及令病人擁有更美觀的疤痕。微創外科的出現革新了許多疾病的治療方法，如先天性巨結腸症，肛門閉瑣及胃食道返流。其應用並無年齡限制，在新世紀裡，隨著科技的不斷進步，外科經驗及技術的不斷提升，腹腔鏡手術無疑會在嬰幼兒中更廣泛地應用，而且會在大多數病例中取代傳統的手術方法。