经脐缘小切口肠套叠整复术在儿童急性肠套叠中的应用  

Open reduction of acute pediatric intussusception through inferior umbilical skin fold incision

作　　者：鲍俏[1] 李宁[1] 周学锋[1] 余克驰[1] 刘芳娜[1] 孙大昂[1] 毕波[1] 张文[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2015年第1期68-70,共3页Chinese Journal of Pediatric Surgery

基　　金：国家临床重点专科建设项目（国卫办医函[2013]544号）

摘　　要：目的探讨经脐缘小切口行肠套叠整复术的可行性及治疗经验。方法回顾性分析2011年6月至2013年11月间26例急性肠套叠患儿行经脐缘小切口行肠套叠整复术的临床资料。本组26例患儿年龄3～28个月，平均11．2个月。起病时间均在48h内，给予空气灌肠，采用100mmHg压力超过15min未能复位成功。手术沿脐窝下方皮肤褶皱做弧形切口，先将回肠末端提出使套叠肠管位于切口下方，然后右手手指经切口伸入腹腔，并通过双手在腹壁外的配合完成肠套叠复位。结果25例患儿经脐缘切口顺利完成肠套叠整复术，其中1例患儿在复位中发现为梅克尔憩室引起肠套叠，同时经脐部切口完成梅克尔憩室切除术，1例患儿因复位困难将切口向右侧延长2cm后完成手术，平均手术时间为29min。术后1例患儿出现伤口脂肪液化，无伤口裂开、迟发型肠穿孔等并发症。术后1个月随访，患儿均未见肠套叠复发，伤口隐藏于脐缘，不易发现。结论对于起病时间短，一般情况良好的患儿，大多数能采用经脐切口完成肠套叠整复术。手术伤口小，不易发生伤口裂开等并发症。且术后手术瘢痕位于脐缘，起到较好的美容效果。对于复位困难的患儿，适当延长切口，也能完成手术，并不增加手术风险与难度。Objective To evaluate the feasibility of open reduction of pediatric intussusception through inferior umbilical skin fold incision. Methods During June 2011 and November 2013, 26 cases of acute pediatric intussusceptions underwent open reduction through inferior umbilical skin fold incision. The mean age was 11.2 （3-28） months. The time from initial symptom to hospitalization was within 48 hours. Air enema was performed but failed in reduction. The surgical incision was arc- shaped along inferior umbilical skin fold. Distal ileum was extracted until intussusception part came under the incision. Then right finger was extended into abdominal cavity for intussusception reduction with the assistance of both hands outside abdominal wall. Results Twenty-five cases of intussusceptions were successfully reduced. The average operative duration was 29 min. One case required incision extension by 2 cm because of reduction difficulty. And another 1 case of Meckel＇s diverticulum was intraoperatively removed. Except for 1 case of fat liquefaction, there was no occurrence of such complications as infection, dehiscence or enterobrosis. After 1 month, the scars were invisible within the fold of navel skin. The surgical indications are for children with stable signs and a short onset time. Most cases of acute intussusception may be managed by open reduction through inferior umbilical skin fold incision. With only a small incision, it has fewer postoperative complications. For more difficult cases, proper extension of incision may achieve reduction without higher risk or complexity. Conclusions The surgical indications of open recluction through inferion umbibical skin fold incision are for children with stable signs and a short onset time. Most cases of acute intussusception may be managed by open reduction through inferior umbilical skin fold incision. With only a small incision, it has fewer postoperative complications. For more difficult cases, proper extension of incision may achieve reduction without higher risk or comp

关 键 词：肠套叠 消化系统外科手术方法 可行性研究 

分 类 号：R726.5[医药卫生—儿科]