腹腔镜手术治疗小儿急性肠套叠82例

Laparoscopic treatment of children acute intussusception

目的：总结腹腔镜治疗小儿急性肠套叠的临床经验。方法2008年8月至2013年5月，我们对82例急性肠套叠患儿实施腹腔镜手术治疗。在腹腔镜直视下行肠套叠整复术，对于难复性肠套叠，术中辅助空气灌肠，复位后观察套叠肠管生机，探查末端回肠1 m以上及肠系膜淋巴结肿大情况，对有肠坏死或器质性病变者，扩大脐孔提出病变肠管，行肠切除肠吻合术，在腹腔镜下切除阑尾或淋巴结活检，对合并腹股沟斜疝者同时手术。结果82例中，77例腹腔镜下复位成功，5例因发现肠坏死或套叠过紧而中转开腹手术。术中发现13例有肠管器质性病变，75例非小肠套叠者予以阑尾切除术，平均手术时间6 min，5例合并腹股沟斜疝者同时行腹腔镜下疝囊高位结扎术，平均单侧手术时间5 min，总手术时间平均为52 min。术后平均随访时间2年9个月，无一例复发。结论腹腔镜治疗小儿急性肠套叠安全可靠，可清楚探查有无肠管器质性病变，对合并腹股沟斜疝可酌情同时手术治疗，效果满意，但应严格把握手术指征，熟练掌握操作流程。

Objetive To summarize the clinical experience of curing the acute intussusception in chil-dren by laparoscopy. Methods 82 cases of acute intussusception in children were operated by laparoscopy. Results 77 cases were reseted successfully by laparoscopy,5 cases were reversed to open when found intesti-nal necrosis or invagination too tight during the operation.There were 1 3 cases with structural disease were found during the operation,75 cases done appendectomy were not the intestine intussusception,the average op-eration time was 6 min,5 cases combined with oblique inguinal hernia done high ligation of hernial sac by lapa-roscopy,the average operation time was 5 min,the average time of whole operation was 52 min.The average followed up time was 33 months after the operation,and no one recured. Conclusion To hold the operating indication strictly,and keep the operation consummate,it is safely for curing acute intussusception in children by laparoscopy,exploring the organic disease weather or not after resetting the intussusception,if combined with oblique inguinal hernia,could do the operation at the same time,and the effect wis satisfaction.It is fully to reveal the superiority of exploration and mini-injury by laparoscopic operation.