腹腔镜与传统开腹手术治疗小儿肠套叠的临床疗效比较  

Laparoscopic Versus Open Reduction of Intussusception in Children

作　　者：孙俊[1] 徐伟珏[1] 吕志宝[1] 刘江斌[1] 黄雄[1] 黄一敏[1] 吴一波[1] 陈舟[1] 盛庆丰[1] 

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院普外科,上海200062

出　　处：《中国微创外科杂志》2017年第5期422-424,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜手术治疗小儿肠套叠的临床价值。方法回顾性分析2014年5月~2015年5月15例腹腔镜手术(腹腔镜组)治疗小儿肠套叠的临床资料,并与同期22例传统开腹手术(开腹组)进行比较,比较2组手术时间、恢复正常饮食时间、住院时间及并发症等。结果腹腔镜组13例腔镜下复位,成功率86.7%(13/15),中转开腹2例。腹腔镜组手术时间稍短,但2组差异无统计学意义[中位数55 min(39~146 min)vs.67 min(49~158 min),Z=-1.657,P=0.098]。与开腹组比较,腹腔镜组术后恢复正常饮食时间明显缩短[(4.2±1.3)d vs.(5.5±2.1)d,t=-2.007,P=0.053],2组住院时间无统计学差异[(5.2±1.4)d vs.(6.5±2.2)d,t=-1.756,P=0.089]。2组术中、术后并发症各4例,无统计学差异(Fisher精确检验,P=0.433)。腹腔镜组15例随访6~17个月,(11.0±3.5)月:1例术后2个月再次发生肠套叠,经空气灌肠复位成功;余均无异常,无粘连性肠梗阻发生。传统组22例随访6~17个月,(10.7±3.0)月:1例术后1个月发生小肠梗阻,经保守治疗后好转;1例术后3个月再次发生肠套叠,经空气灌肠复位成功;余无异常。结论腹腔镜手术治疗小儿肠套叠安全、有效,不增加术中、术后并发症,对于熟悉腹腔镜操作的医生可作为首选治疗方案。Objective To explore the clinical value of laparoscopic reduction of intussusception in children. Methods A retrospective review was performed to evaluate outcomes of patients with intussusception who were treated with laparoscopical reduction （ LAP group, n = 15 ） or with exploratory laparotomy （ OPEN group, n = 22） from May 2014 to May 2015. The operation time, normal diet time, length of hospital stay, and complications were compared between the two groups. Results In the LAP group, laparoscopical reduction was successfully completed in 13 cases （ 86.7% ） while a conversion to open procedure was required in 2 cases. The median operation time was not statistically different between the two groups [ 55 miu （39 - 146 rain） vs. 67 rain （49 - 158 min）, Z = -1. 657, P = 0. 0981. As compared to the OPEN group, the postoperative time to normal diet was significantly shorter [ （4.2 ± 1.3） d vs. （5.5 ± 2.1 ） d, t = - 2. 007, P = 0. 053 ] in the LAP group and the length of hospital stay was not significantly different[ （5.2 ± 1.4） d vs. （6.5 ± 2.2） d, t = - 1. 756, P = 0. 089 ] between the two groups. The intraoperative or postoperative complications occurred in 4 cases in both groups, without statistical difference （ Fisher＇ s exact test, P = 0. 433）. The LAP group （ 15 cases） was followed up for 6 - 17 months （ 11.0 ± 3.5 months）. Reoccurance of intussusception occurred in 1 case two months after surgery and was successfully treated with air reduction. No adhesive obstruction was found. The OPEN group （22 cases） was followed for 6 -17 months （10.7 ± 3.0 months）. Intestinal obstruction occurred in 1 case at the first postoperative month, which was treated with conservative management. Reoccurance of intussusception happened in 1 case at the third postoperative month and was successfully treated with air reduction. Conclusions Laparoscopy is safe and effective in the treatment of pediatric intussusceptions. Pediatric surgeons with adequate minimally invasive

关 键 词：肠套叠 腹腔镜 小儿 

分 类 号：R726.5[医药卫生—儿科]