脐部两孔法腹腔镜手术在儿童小肠出血中的诊断价值及治疗效果

The diagnostic value and therapeutic effect of umbilical two hole method laparoscopic surgery in children with small intestinal bleeding

目的探讨脐部两孔法腹腔镜手术在儿童小肠出血中的诊断价值及治疗效果。方法选取2008年1月~2012年6月邹城市人民医院小儿外科收治的小肠出血性疾病患儿33例,所有患儿均行放射性核素扫描（ECT）检查,并结合腹腔镜探查,比较ECT检查与腹腔镜检查的结果。结果21例经ECT检查为阳性的患者,腹腔镜检查均为阳性;12例经ECT检查阴性患儿,经腹腔镜检查,10例为阳性,2例为阴性;31例患儿经手术治疗后均痊愈出院,随访1年未出现明显并发症。ECT及腹腔镜检查均为阴性的患儿2例,术后对症治疗,出血停止后出院。结论怀疑儿童小肠出血时,在排除胃、结肠病变所致的出血情况下,应优先考虑ECT检查确诊,再结合脐部两孔法腹腔镜探查术,可有效地提高诊断准确率,减少开腹探查的盲目性及创伤性,具有较大的临床价值。

Objective To explore the application effect of umbilical two hole method laparoscopic surgery in children with small intestinal bleeding. Methods 33 cases of children with intestinal hemorrhagic disease were collected, and they were examined by ECT and laparoscopic exploration, then compared the examination results between ECT and aparoscopic. Results 21 cases of children who were positive by ECT were positive all by laparoscopic examination; Among 12 cases who were negative in ECT, there were 10 cases positive by laparoscopic examination; after operation treatment, they were cured,and no complications appeared during 1 years followed up.The 2 cases who were negative both in ECT and laparoscopy were done symptomatic treatment. After operation, they discharged after bleeding stopped.Conclusion In removal of bleeding caused by stomach, colonlesions, ECT diagnosis should be given to prioritily,t hen combined with at umbilical round, two holes laparoscopy can improve diagnostic accuracy of children intestinal bleeding,reduce blindness and trauma of exploratory laparotomy,and the wound after healing has beauty effect,it has great clinical value.