脐部两孔腹腔镜结合ECT诊治小儿小肠出血  

Application of laparoscopy combined with emission computed tomography in diagnosis and therapy ofsmall intestine hemorrhage in children

作　　者：杨俊[1] 汤绍涛[1] 段栩飞 卞红强[1] 郑凯[1] 梁种[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,武汉430022 [2]武汉妇女儿童医疗保健中心小儿普外科 ,武汉430022

出　　处：《中华小儿外科杂志》2012年第6期446-448,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的总结脐部两孔腹腔镜结合ECT（emissioncomputedtomography，ECT）在小儿小肠出血诊断和治疗中的应用经验。方法我院2004年1月至2010年12月共收治167例消化道出血患儿，其中72例患儿反复便血患儿进行99^m锝酸盐（99^mTc）显像检查，均行腹腔镜探查术。结果72例中59例ECT阳性患儿均经腹腔镜探查及病理证实，其中47例梅克尔憩室，9例小肠重复畸形，3例为血管瘤；13例ECT阴性患儿7例经手术及病理证实为梅克尔憩室，2例为肠重复畸形，1例蓝色橡皮疱痣综合征，2例为过敏性紫癜导致的肠道出血，1例未见器质性病变。以上患儿均治愈，术后随访3个月至6年未见出血。结论ECT检查可作为小肠出血的首选无创检查。脐部两孔腹腔镜结合ECT检查对小儿小肠出血不仅可以提高诊断率，而且又具有治疗价值，切口美观，创伤小，并可减少开腹探查的盲目性及创伤性。Objective To explore the clinical application value of two port laparoscopy combined with emission computed tomography （ECT） in diagnosis and therapy of pediatric small intestine hem- orrhage. Methods 167 children associated with gastrointestinal hemorrhage were admitted in our cen- ter from January 2004 to December 2009. 99^m Tc-pertechnetate abdominal scintigraphy was performed in 72 patients with a history of recurrent hemafecia or melena, and they were targeted for present study. All the 72 patients underwent laparoscopic exploration. Results Among the 72 patients,59 pa tients showed positive results in scintigraphy. They were further confirmed by laparoscopic surgery and pathological examinations, including Meckel＇s diverticulum in 47 and duplications of alimentary tract in 9, and angioma in 3. Remain 13 patients with negative scintigraphy were shown Meckel＇s di- verticulum in 7, duplications of alimentary tract in 2, blue rubber bleb nerus syndrome in 1, and ana- phylaetoid purpura in 2 via laparoscopic surgery and pathogenic examination, and no organic pathologic changes was identified by laparoscopy in 1 patient. All of them recoverd after therapy. No further bleeding was seen in follow up. Conclusions ECT is an important candidate in diagnosis of small in- testine hemorrhage in children. The combination of laparoscopy and radionuclide imaging not only brings benefit to diagnosis and treatment in such patients, but also effectively reduce the damage by conventional open exploratory laparotomy.

关 键 词：胃肠出血 腹腔镜检查术 

分 类 号：R72[医药卫生—儿科]