空气灌肠复位联合无瘢痕微创手术治疗儿童继发性肠套叠

Treatment of secondary intussusception by air enema reduction plus scarless mini-invasive surgery in children

目的探讨空气灌肠联合无瘢痕微创手术治疗儿童继发性肠套叠的可行性、安全性。方法回顾性收集2018年1月至2021年1月广州市妇女儿童医疗中心经空气灌肠复位后,再行无瘢痕微创手术(经脐单孔腹腔镜或电子结肠镜手术)切除病理性诱发点的19例继发性肠套叠患儿临床资料。按照引起继发性肠套叠的原因分为两组:一组为结肠息肉所致(9例),均经空气灌肠复位成功,其中7例经电子结肠镜切除息肉,2例行经脐单孔腹腔镜手术切除息肉。另一组为非结肠息肉所致(10例),其中7例为继发性小肠套叠,3例为继发性回结型肠套叠;5例经空气灌肠复位成功,5例套叠肠管明显缩短;10例均采取经脐单孔腹腔镜探查术,术中找到病理性诱发点后,提出已复位肠管或腔镜下复位后提出病变肠管,切除病理性诱发点。结果19例均经无瘢痕微创手术切除病理性诱发点,其中经脐单孔腹腔镜手术12例,电子结肠镜手术7例,无一例中转开放手术。术后病理结果提示结肠息肉9例,梅克尔憩室6例,小肠息肉2例,回盲部淋巴瘤1例,回盲部囊肿型重复畸形1例。19例均痊愈出院,随访5~36个月,无一例肠梗阻、复发肠套叠发生,腹部均无可视性手术瘢痕。结论空气灌肠复位联合无瘢痕微创手术可用于治疗儿童继发性肠套叠,具有创伤小、恢复快、美观的优势。

Objective To explore the feasibility,safety and prognosis of air enema plus scarless mini-invasive surgery for secondary intussusception in children.Methods From January 2018 to January 2021,clinical data were retrospectively reviewed for 19 children with secondary intussusception undergoing reduction by air enema and scarless mini-invasive surgery(transumbilical single-port laparoscopy or electronic colonoscopy).One group(n=9)caused by colonic polyps were successfully reduced by air enema.There were electronic colonoscopy(n=7)and transumbilical single-port laparoscopy(n=2).The other group(n=10)included secondary small intestine intussusception(n=7)and secondary ileocolic intussusceptions(n=3).After air enema,there were successful reduction(n=5)and marked shortening(n=5).Under an exploration of umbilical single-port laparoscopy,the pathologic lead points were identified and resected.Results Transumbilical single-port laparoscopy(n=12)and electronic colonoscopy(n=7)were performed successfully without any conversion into laparotomy.Postoperative pathologies included colon polyp(n=9),Meckel's diverticulum(n=6),small intestine polyp(n=2),ileocecal lymphoma(n=1)and ileocecal cyst duplication(n=1).All were cured and discharged.During a follow-up period of(5-36)months,there was no recurrence of intestinal obstruction or intussusceptions.And no visible abdominal surgical scar was noted.Conclusion Air enema reduction plus scarless mini-invasive surgery may be used for children with secondary intussusceptions.It offers the advantages of minimal trauma,quick recovery and perfect cosmetics.