腹腔镜下球囊扩张法与传统开腹手法复位治疗肠套叠的临床疗效对比研究

A comparative study on the clinical effects between laparoscopic ballon dilation and traditional open reduction in treatment of intussusception in children

目的:探讨Foley导尿管球囊扩张法与传统开腹手法复位在小儿肠套叠复位术中的治疗效果。方法:回顾性分析2015年8月至2019年7月兰州大学第二医院小儿外科通过Foley导尿管球囊扩张辅助腹腔镜下肠套叠复位与传统开腹手法复位的肠套叠患儿共68例,其中Foley导尿管组32例,传统开腹组36例。Foley导尿管组实施腹腔镜下Foley导尿管球囊扩张套叠肠管鞘部复位治疗;传统开腹组实施传统开腹手术,术中采用术者手指扩张套叠肠管鞘部复位治疗。对比2组患儿手术治疗效果、术后恢复效果及短期并发症、患儿满意度及远期并发症。结果:手术治疗效果指标中,Foley导尿管组手术时间[(0.4±1.1)h]、术中出血量[(10.2±3.4)mL]、手术切口大小[(0.5±0.4)cm]、鞘部肠管破裂发生率[6.3%(2/32例)]均低于传统开腹组[(1.3±2.9)h、(40.5±2.1)mL、(5.1±0.7)cm、30.6%(11/36例)],差异均有统计学意义(均P<0.05);在术后恢复效果及短期并发症指标中,Foley导尿管组胃肠功能恢复时间[(1.2±3.1)d]、住院时间[(6.7±1.8)d]、切口感染发生率[9.4%(3/32例)]、切口疝发生率(0)均低于传统开腹组[(3.3±6.4)d、(7.3±0.9)d、36.1%(13/36例)、16.7%(6/36例)],差异均有统计学意义(均P<0.05);在患者满意度及远期并发症指标中,Foley导尿管组家属满意度评分[(8.7±1.2)分]高于传统开腹组[(6.6±3.1)分],黏连性肠梗阻发生率低于传统开腹组[0比19.4%(7/36例)],差异均有统计学意义(均P<0.05)。结论:与传统开腹手法复位比较,Foley导尿管球囊扩张在小儿肠套叠复位的治疗中,具有手术时间短、术中操作安全、肠管损伤发生率低及出血少等优势,同时具有切口小、恢复快、住院时间短、家长满意度高等优点,且有较低的切口感染、切口疝、术后肠黏连等并发症发生率。

Objective To investigate and compare the therapeutic effect of Foley catheter balloon dilation and the traditional open reduction in the treatment of intussusception in children.Methods A total of 68 children with intussusception treated by Foley catheter balloon dilatation by laparoscopic surgery or traditional open reduction in Department of Pediatric Surgery,the Second Hospital of Lanzhou University from August 2015 to July 2019 were retrospectively analyzed.Among them,there were 32 cases in the Foley catheter group and 36 cases in the traditional laparotomy group.Foley catheter group were treated with laparoscopic Foley catheter balloon dilatation,while the traditional open group were treated with traditional open surgery which was performed with finger dilatation.The results of surgical treatment,postoperative recovery,short-term complications,patient satisfaction and long-term complications were compared between the two groups.Results Among the indexes of surgical treatment effect,the operation time[(0.4±1.1)h],intraoperative bleeding volume[(10.2±3.4)mL],incision size[(0.5±0.4)cm]and incidence of the rupture of intestine[6.3%(2/32 cases)]in the Foley catheter group were significantly lower than those in the traditional open group[(1.3±2.9)h,(40.5±2.1)mL,(5.1±0.7)cm,30.6%(11/36 cases)],and the differences were statistically significant(all P<0.05).Among the indexes of postoperative recovery and short-term complications,recovery time of gastrointestinal function[(1.2±3.1)d],length of hospital stay[(6.7±1.8)d],incidence of incision infection[9.4%(3/32 cases)]and incidence of incisional hernia(0)in the Foley catheter group were significantly lower than those in the traditional open group[(3.3±6.4)d,(7.3±0.9)d,36.1%(13/36 cases),16.7%(6/36 cases)],and the differences were statistically significant(all P<0.05).Among the indexes of family satisfaction and long-term complications,the score of family satisfaction in the Foley catheter group[(8.7±1.2)scores]was significantly higher than that in the traditional open group[(6.6±3.1)scores],and the incidence of adhesive intestinal obst-ructionin the Foley catheter group(0)was significantly lower than that in the traditional open group[0 vs.19.4%(7/36例)],and the differences were statistically significant(all P<0.05).Conclusions Compared with traditional open reduction in the treatment of intussusception in children,Foley catheter balloon dilation has the advantages of short operation time,safe operation,low incidence of intestinal injury,less bleeding,and so on,and also has the advantages of small incision,fast recovery,short hospitalization time,high satisfaction of parents.In addition,the Foley catheter balloon dilation has a lower incidence of incisional infection,incisional hernia,postoperative intestinal adhesion and other complications.