腹腔镜下回盲部三点固定法预防小儿肠套叠复发  

LAPAROSCOPIC ILEOCOLONIC PIXIE TO DECREASE SUBSEQUENT RECURRENCES OF INTUSSUSCEPTION WITH MORE THAN TWO RECURRENCES

作　　者：李扬 李炳 

机构地区：[1]辽宁省锦州市妇婴医院小儿外科,121000 [2]江苏淮安市妇女儿童医院小儿外科

出　　处：《中国煤炭工业医学杂志》2017年第4期372-375,共4页Chinese Journal of Coal Industry Medicine

基　　金：国家十一五科技支撑计划课题(编号:2006BA105A06)

摘　　要：目的复发性肠套叠灌肠复位成功以后,早期应用腹腔镜技术行回盲部固定法,减少远期肠套叠复发及急诊剖腹手术的机会。探讨该技术的可行性及临床效果。方法 2014年2—11月,笔者对反复发作的肠套叠患儿,早期应用腹腔镜技术行回盲部固定法10例,其中男8例,女2例;年龄6~36个月,平均12.5个月。于脐部纵切口开放式置入5mm Trocar置入腹腔镜,然后分别于耻骨联合上方腹横纹处和左下腹置入2个3~5mm Trocar,放置操作器械进行探查,排除肠套叠的起源点,常规切除阑尾后,将升结肠起始部、阑尾根部和回肠末端用不可吸收的缝线分别固定于右侧腹壁。结果手术时间为45~85min,平均(59.4±13.11)min。无中转手术病例,术中出血极少。本组所有患儿术中未发现肠套叠起源点,无腹腔镜手术相关并发症。术后随访3~12个月,平均(7.2±3.12)个月,随访期间无肠套叠复发病例,无肠梗阻。结论对于反复发作的肠套叠患儿在灌肠复位成功后,早期应用腹腔镜进行干预,并行腹腔镜下回盲部固定法预防肠套叠复发,安全有效,可以发现相关畸形,排除肠套叠的起源点,并明确肠套叠是否完全复位,避免肠套叠复发及远期复发的相关并发症和急诊剖腹手术。Objective To describe and assess our initial experience to decrease subsequent recurrences for selected patients and lower the risk of further emergent open surgery by early laparoscopic ileocolonic pixie with nonabsorbable sutures. Methods A retrospective review of early laparoscopic ileocolonic pixie in 10 cases from February 2014 to November 2014 was performed. Among the patients, 8 were male, 2 were fe- male at an age range from 6 months-36 months （mean 12.5 months）. A 5 mm longitudinal incision was made in the center of umbilical, the first cannula was inserted in an open fashion and a 5 mm laparoscope was introduced. Another 2 trocars were introduced by 3 - 5 mm incision in left low site and above the pubic symphysis respectively. After thorough abdominal exploration, an appendectomy and an ileocolonic pixie with nonahsorbable sutures were performed simultaneously for all the children after the last successful air enema reduction. Results The mean operative time was 59.4 ± 13.11 rain （range, 45 - 85 min）. No cases required conversion to open surgery, blood loss was minimal. There was no operative morbidity, and no lead point was found in any child. The 10 cases were followed up for 3 - 12 months （mean, 7.2 ± 3.12 months） ; no recurrence was observed during this period, no adhesive small bowel obstruction. Conclusions The results suggest that early intervention should be undertaken for intussusception with multiple recur- rences in children after the last nonsurgical reduction has been attempted successfully. It allows differentia- tion of a specific etiologic lesion, the possibility of incomplete reduction, and additional proximal invagina- tions. Later complications, such as repeat recurrence and associated surgical morbidity, also can be avoi- ded.

关 键 词：小儿 肠套叠 腹腔镜 复发 

分 类 号：R656.1[医药卫生—急诊医学]