经脐单部位腹腔镜手术在小儿外科的临床应用与进展

Clinical Applications and Advances of Transumbilical Single Incision Laparoscopic Surgery in Pediatric Surgery

摘要: 微创理念的深入推动小儿外科的诊疗模式向“无瘢痕手术”发展。随着腹腔镜技术在小儿外科中的发展，美观、创伤小、恢复快等成为外科医生的目标。经脐单部位腹腔镜手术(Transumbilical Single Incision Laparoscopic Surgery, TUSILS)凭借利用脐部自然皱褶隐藏切口的优势，实现了微创与美容的双重获益。目前，该技术广泛应用至小儿普外、肝胆、泌尿及肿瘤等亚专科，由简单切除向复杂重建手术发展。TUSILS同时也存在固有的“操作三角”丧失、器械相互干扰(筷子效应)以及陡峭的学习曲线等不足。自制手套装置凭借制作简便、成本低、适配性强的优势，解决了小婴儿手术中器械移位漏气的问题；达芬奇机器人单孔腹腔镜技术依托可弯曲机械臂、三维高清视野等优势，解决了“筷子效应”与精准操作难题，但其因微型器械缺乏、成本高昂、培训体系不完善，在小儿外科的应用仍处于探索阶段。本综述探讨TUSILS在小儿外科的临床应用现状、技术争议以便更好地运用于临床具有重要意义。

Abstract: The advancement of minimally invasive principles has propelled paediatric surgical practice towards scarless surgery. With the development of laparoscopic techniques in paediatric surgery, aesthetic outcomes, minimal trauma, and rapid recovery have become key objectives for surgeons. Transumbilical Single-Incision Laparoscopic Surgery (TUSILS) leverages the natural umbilical crease to conceal the incision, delivering dual benefits of minimally invasive technique and cosmetic outcome. This approach is now widely applied across paediatric general surgery, hepatobiliary, urological, and oncological subspecialties, evolving from simple resections to complex reconstructive procedures. However, TUSILS inherently presents challenges including loss of the operative triangle, instrument interference (the chopstick effect), and a steep learning curve. The self-made glove device, characterised by its simplicity of construction, low cost, and strong adaptability, resolves the issue of instrument displacement and air leakage during infant surgery. Da Vinci robotic single incision laparoscopic technology, leveraging advantages such as flexible robotic arms and three-dimensional high-definition visualisation, addresses the challenges of the “chopstick effect” and precise manipulation. However, due to a lack of micro-instruments, high costs, and an incomplete training system, its application in paediatric surgery remains in an exploratory phase. This review examines the current clinical application and technical controversies surrounding TUSILS in paediatric surgery, highlighting its significance for optimising clinical implementation.