腹腔镜技术治疗小儿粘连性肠梗阻的体会  

Experience of Laparoscopic Surgery for Adhesive Ileus in Children

作　　者：陈琦[1] 周维 黄华[1] 王鹏[1] 李晓月 谭诗坤 Chen Qi;Zhou Wei;Huang Hua(Department of General Pediatric Surgery,Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院小儿普外科

出　　处：《中国微创外科杂志》2020年第1期85-87,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜技术治疗小儿粘连性肠梗阻的应用价值。方法回顾性分析2014年1月~2019年1月完全腹腔镜肠粘连松解术82例资料。年龄2个月~14岁,完全性肠梗阻60例,不全性肠梗阻22例。先于脐缘左侧开放直视下置5 mm trocar和光源,腹腔镜下探查粘连程度(决定是否需要中转开腹),腔镜监视下于左侧腹直肌外缘上下各置5 mm trocar,进无损伤抓钳和超声刀。小心松解粘连索带及粘连的肠管,解除梗阻,游离肠管,明确并处理梗阻原因。结果术后诊断Meckel憩室并发肠梗阻15例,脑积水脑室腹腔分流术后并发粘连性肠梗阻5例,阑尾炎并发粘连性肠梗阻17例,腹内疝并发肠梗阻8例,手术后粘连性肠梗阻37例。术中1例肠粘连松解时肠管损伤,行肠吻合术。手术时间120~240 min,(172.2±24.1)min,出血量5~15 ml。术后1~3天可自行排便,术后5~8天出院,无切口愈合不良。随访3个月~5年3个月,中位数34个月,生长发育正常,2例再次发生不全性肠梗阻。结论完全腹腔镜技术治疗小儿粘连性肠梗阻安全可行。Objective To explore the application value of complete laparoscopy in the treatment of adhesive ileus in children.Methods Clinical data of 82 pediatric patients undergoing complete laparoscopic enterolysis from January 2014 to January 2019 were retrospectively analyzed.Their ages ranged from 2 months to 14 years old.There were 60 cases of complete intestinal obstruction and 22 cases of incomplete intestinal obstruction.A 5-mm trocar and light source were placed on the left side of umbilical margin under open vision to explore the adhesion degree under laparoscope(to decide whether or not to turn to laparotomy).Under endoscopic monitoring,two 5-mm trocars were placed in the left upper and lower abdomen respectively,and non-damaged grasping forceps and ultrasonic knife were performed.The adhesive cord and intestinal canal were carefully loosened,the obstruction was removed,the intestinal canal was dissociated,and the cause of obstruction was identified and dealt with.Results After surgery,there were 15 cases of Meckel’s diverticulum complicated with intestinal obstruction,5 cases of adhesion intestinal obstruction after ventriculoperitoneal shunt of hydrocephalus,17 cases of appendicitis complicated with adhesion intestinal obstruction,8 cases of internal hernia complicated with intestinal obstruction,and 37 cases of adhesion intestinal obstruction after previous surgery.Intestinal anastomosis was performed to repair intestinal adhesion in 1 case.The operation time was 120-240 min,with an average of(172.2±24.1)min.The blood loss was 5-15 ml.The patients could defecate in 1-3 days after the operation,and were discharged from the hospital 5-8 days after the operation with good recovery and no poor wound healing.The patients were followed up for 3 months to 5 years and 3 months and the median follow-up time was 34 months.The growth and development were normal.There were 2 cases of incomplete intestinal obstruction occurred again.Conclusion Complete laparoscopy is safe and feasible for the treatment of adhesive inte

关 键 词：腹腔镜 粘连性肠梗组 儿童 

分 类 号：R65[医药卫生—外科学]