腹腔镜下根部缝扎法在梅克尔憩室切除中的应用  

Application of laparoscopic basal ligation followed by diverticulectomy-only for bleeding Meckel's diverticulum

作　　者：匡后芳[1] 闫学强[1] 段栩飞[1] 杨俊[1] 卞红强[1] 朱真闯[1] 王海斌 Kuang Houfang;Yan Xueqiang;Duan Xufei;Yang Jun;Bian Hongqiang;Zhu Zhenchuang;Wang Haibin(Department of General Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)普外科,武汉430016

出　　处：《中华小儿外科杂志》2020年第4期325-329,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的 探讨腹腔镜下根部缝扎法在梅克尔憩室(meckel diverticulum,MD)并出血患儿中的应用价值。方法 收集2017年1月至2018年12月期间华中科技大学同济医学院附属武汉儿童医院收治的经病理学检查诊断为MD并出血患儿资料共40例,其中男32例,女8例;腹腔镜辅助下Meckel憩室切除肠吻合术或经脐部切口提出行肠切除肠吻合手术组(切吻组)22例,腹腔镜下根部缝扎切除手术组(缝扎组)18例。两组患儿的中位年龄分别为55.00个月和30.50个月。回顾性分析MD并出血患儿的临床资料,包括手术时间、出血量、术后进食时间、早期并发症(肠瘘,伤口感染)及随访(再出血,粘连性肠梗阻)等。比较切吻组和缝扎组之间的差异是否具有统计学意义。结果 切吻组手术时间为(85.00±19.12)min,出血量为(1.50±0.52)ml,术后进食时间为(4.35±0.74)d,住院时间(8.71±1.49)d;缝扎组手术时间为(41.00±6.15)min,出血量(0.96±0.45)ml,术后进食时间为(2.17±0.39)d,住院时间(5.67±0.65)d。上述结果两组间进行比较,差异具有统计学意义(P<0.05),缝扎组明显优于切吻组。对两组间术后病理学检查结果及近远期并发症进行比较,差异无统计学意义。结论 腹腔镜下根部缝扎法与目前多采用的腹腔镜辅助下肠切肠吻合手术相比较,具备操作简单、创伤小、临床效果理想等优势,可作为MD切除的一种选择方式。Objective To explore the value of laparoscopic basal ligation followed by diverticulectomy-only for bleeding Meckel's diverticulum(MD)in children.Methods Clinical data were retrospectively reviewed for pathologically diagnosed MD children with digestive tract bleeding from January 2017 to December 2018.There were 32 boys and 8 girls.Laparoscopic diverticulum resection or segmental enterectomy was followed by intestinal anastomosis(n=22,resection and anastomosis group)while laparoscopic basal ligation followed by diverticulectomy-only(n=18,ligation group).The median age of two groups was 55.00 and 30.50 months respectively.The details of operative duration,bleeding volume,postoperative fasting time and early postoperative complications(intestinal fistula&wound infections)and follow-ups(rebleeding&adhesive ileus)were compared for two groups.Results Operative duration,bleeding volume,postoperative fasting time and hospital stay of two groups were(85.00±19.12)min,(1.50±0.52)ml,(4.35±0.74)days,(8.71±1.49)days versus(41.00±6.15)min,(0.96±0.45)ml,(2.17±0.39)days,(5.67±0.65)days.Inter-group statistical difference existed in the above results(P<0.05).Ligation was significantly superior to resection and anastomosis.No significant inter-group difference existed in postoperative pathology or short/long-term complications.Conclusions As compared with current laparoscopic assisted resection and anastomosis surgery,laparoscopic basal ligation offers the advantages of lesser trauma,easier handling and ideal clinical efficacy.It should be considered as one of surgical options for bleeding MD.

关 键 词：儿童 梅克尔憩室 腹腔镜手术 根部缝扎 

分 类 号：R726.5[医药卫生—儿科]