腹腔镜修补术治疗儿童十二指肠溃疡穿孔的效果及安全性分析  

Effectiveness and safety analysis of laparoscopic repair for perforated duodenal ulcer in children

作　　者：李钰坤 王立勇[1] 叶镇彭[1] 黄荏安 黄立平 李泽民 LI Yu-kun;WANG Li-yong;YE Zhen-peng(Department of Pediatric Surgery,Dongguan People’s Hospital,Dongguan 523000,China)

机构地区：[1]东莞市人民医院小儿外科,523000

出　　处：《中国实用医药》2022年第6期41-44,共4页China Practical Medicine

摘　　要：目的分析腹腔镜修补术治疗儿童十二指肠溃疡穿孔的疗效及安全性。方法回顾性分析7例十二指肠溃疡穿孔患儿的临床资料,所有患儿均行腹腔镜修补术治疗。记录患儿中转开腹情况、手术时间、术后胃管停留时间、恢复进食时间、腹腔引流管拔除时间、治疗效果、再次手术情况、并发症(消化道出血、伤口感染、腹腔脓肿、缝合口漏、肠梗阻及呼吸道感染、心力衰竭、感染性休克)发生情况、住院时间、幽门螺杆菌治疗情况。结果7例患儿均顺利完成腹腔镜修补术,无中转开腹。手术时间45~120 min,平均手术时间(80±20)min。术后胃管停留时间3~4 d,恢复进食时间3~5 d,腹腔引流管拔除时间3~5 d。所有患儿均痊愈出院,无再次手术患儿。未发生消化道出血、伤口感染、腹腔脓肿、缝合口漏、肠梗阻及呼吸道感染、心力衰竭、感染性休克等并发症发生情况。住院时间7~11 d,平均住院时间(8.8±2.5)d。4例术后检测幽门螺杆菌阳性患儿于门诊消化内科正规治疗后转为阴性。随访时间1~5年,未见再次穿孔、便血、贫血、营养不良及腹痛、呕吐等肠粘连肠梗阻表现。结论儿童十二指肠溃疡穿孔多无前驱消化性溃疡或胃炎病史,幽门螺杆菌感染、应用糖皮质激素、非甾体类抗炎药等药物及不规律饮食是引起儿童十二指肠溃疡穿孔的主要病因,腹腔镜修补术治疗儿童十二指肠溃疡穿孔安全、有效,其创伤小、临床效果佳。Objective To analyze the efficacy and safety of laparoscopic repair for perforated duodenal ulcer in children.Methods The clinical data of 7 children with duodenal ulcer perforation were retrospectively analyzed,and all children were treated with laparoscopic repair.The conversion to laparotomy,operation time,postoperative gastric tube stay time,feeding recovery time,abdominal drainage tube removal time,therapeutic effect,reoperation,complications(gastrointestinal bleeding,wound infection,abdominal abscess,anastomotic leakage,intestinal obstruction and respiratory tract infection,heart failure,septic shock),hospitalization time,and treatment of Helicobacter pylori were recorded.Results All 7 patients successfully completed laparoscopic repair without conversion to laparotomy.The operation time was 45-120 min,with an average operation time of(80±20)min.Postoperative gastric tube stay time was 3-4 d,feeding recovery time was 3-5 d,and abdominal drainage tube removal time was 3-5 d.All children were discharged from the hospital cured,and no children were reoperated.No gastrointestinal bleeding,wound infection,abdominal abscess,anastomotic leakage,intestinal obstruction,respiratory infection,heart failure,septic shock and other complications occurred.The hospitalization time was 7-11 d,with an average hospitalization time of(8.8±2.5)d.4 children tested positive for Helicobacter pylori after operation were converted to negative after regular treatment in the outpatient gastroenterology department.The follow-up time was 1-5 years,and no re-perforation,blood in the stool,anemia,malnutrition and abdominal pain,vomiting and other manifestations of intestinal adhesions and intestinal obstruction were observed.Conclusion Most children with perforated duodenal ulcer have no history of prodromal peptic ulcer or gastritis.Helicobacter pylori infection,the use of glucocorticoids,non-steroidal anti-inflammatory drugs and other drugs and irregular diet are the main causes of perforated duodenal ulcer in children.Laparoscopic re

关 键 词：十二指肠溃疡穿孔 腹腔镜修补术 儿童 

分 类 号：R726.5[医药卫生—儿科]