腹腔镜联合ECT诊治小儿消化道出血的临床价值

The clinical value of laparoscopy combined with ECT in the diagnosis and treatment of pediatric gastrointestinal hemorrhage

目的:探讨腹腔镜联合ECT诊断与治疗小儿消化道出血的临床价值。方法:34例患儿术前均行ECT检查,其中阳性32例,2例显示阴性且保守治疗(止血、输血等)效果欠佳,术前行胃镜、肠镜检查,排除上消化道出血及结肠病变,34例患儿均行腹腔镜探查。结果:经腹腔镜探查,28例为美克尔憩室,4例为肠重复畸形,1例为B细胞型淋巴瘤浸润回肠,1例探查阴性。ECT检查阳性32例,其中1例为消化道肿瘤,1例经腹腔镜探查结果阴性,经保守治疗未再出现便血;2例ECT检查阴性,行腹腔镜探查发现美克尔憩室。腹腔镜探查阳性的患者均同时行手术治疗,术后均恢复顺利,未见出血。结论:腹腔镜联合ECT诊治小儿消化道出血是安全、可行的,可提高小儿消化道出血的诊断率,值得广泛应用于临床。

Objective： To investigate the clinical value of laparoscopy combined with ECT in the diagnosis and treatment of pediatric gastrointestinal hemorrhage. Methods： All the 34 children who suffered from gastrointestinal hemorrhage got the ECT examination,of which 32 cases were positive and 2 cases were negative. Conventional therapy（ homeostasis and transfusion） was not very effective in the 2 cases. The 2 cases got gastroscopy and enteroscopy examination preoperatively to exclude upper gastrointestinal hemorrhage or colon lesions. All the 34 cases got laparoscopic exploration before surgery. Results： The results of laparoscopic exploration indicated that 28 cases were Meckle diverticulum,4 cases were intestinal duplication,1 case was ileal infiltration of B cell lymphoma,and 1 case was negative. ECT examination indicated positive in 32 children,and one was gastrointestinal tumor,one was laparoscopically negative and no hematochezia was found after conservative treatment. ECT examination indicated negative in 2 cases,and they were confirmed Meckle diverticulum by laparoscopic exploration. The children that were indicated positive by laparoscopic exploration all underwent surgery at the same time,and they recovered uneventfully. No hemorrhage occurred after surgery. Conclusions： Laparoscopy combined with ECT in the diagnosis and treatment of pediatric gastrointestinal hemorrhage is safe and feasible,can improve the diagnostic rate,is worth popularization in clinic.