经脐单孔法腹腔镜手术治疗小儿肠套叠疗效观察

Clinical effect of treating acute pediatric intussusception through transumbilical single-port laparoscope

目的探讨经脐单孔法腹腔镜手术治疗小儿肠套叠的可行性及临床疗效。方法本研究收集了2012年7月至2015年5月间本院经脐单孔法腹腔镜治疗的36例急性肠套叠患儿的临床资料。经脐切口放入Tri-port后置入腹腔镜,建立气腹,反复使用无损伤钳交替缓慢并持续挤压套叠头部,直至套入部缓慢退出鞘部后,于升结肠或套入肠管处使用无损伤钳牵拉使之完全复位。结果 36例患儿顺利完成手术,手术时间(40.4±6.4)min,出血量(6.0±0.5)mL,术后住院时间(6±1)d。腹腔镜下观察到被套入肠管复位后血供情况良好,小部分浆肌层撕裂。其中4例在复位中发现是Meckel憩室引起肠套叠,经脐扩大切口完成Meckel憩室切除+肠吻合术;1例因复位困难将切口向上下端各延长1 cm后完成手术,术后无伤口裂开、迟发型肠穿孔等并发症。随访3个月未见肠套叠复发。结论经脐单孔法腹腔镜手术治疗小儿肠套叠是一种安全、有效、可行的手术方法,并发症少,创伤小,恢复快。

Objective To evaluate the feasibility of open reduction of pediatric intussusception through transumbilical single-port laparoscope MethodsDuring July2012and May2015,36cases of acute pediatric intussusceptions underwent open reduction through transumbilical single-port laparoscope Umbilical incision was made for inserting Tri-port and then laparoscope for establishing pneumoperitoneum Non-destructive pliers was used repeatedly for squeezing sleeve head to allow its exit from sheath And ascending colon or affected intestine was completely reduced ResultsThirty-six cases of intussusception were successfully reduced The estimated volume of blood loss was(60±05)ml and postoperative hospital stay(6±1)days Blood supply was restored for affected intestine and there was only a small area of seromuscular tear There were4cases of Meckel's diverticulum intussusception And umbilical incision was made for expanded resection and anastomosis For one case with a difficult reduction,incision was extended for1cm at both upper and lower ends There was no postoperative onset of wound gaping,delayed perforation or other complications During a follow-up period of3months,no recurrence of intussusception was noted ConclusionTransumbilical single-port laparoscopy is efficacious and safe for acute pediatric intussusception And it offers multiple advantages of mini-invasiveness,quicker recovery,minimal incision and fewer postoperative complications