腹腔镜治疗53例小儿肠套叠的体会

Laparoscopic treatment of intussusception in 53 children

目的探讨腹腔镜治疗小儿肠套叠的应用及手术方式。方法2013年1月至2019年6月本院采用腹腔镜手术或腹腔镜辅助手术成功治疗小儿急性肠套叠53例。术中腹腔镜探查病变情况并采取相应的手术方式。结果42例经腹腔镜直视下复位成功,9例在腹腔镜直视下由肛门空气灌肠辅助复位成功,镜下复位率96.23%;2例复位困难,经脐部延长切口,复位成功。2例经腹腔镜探查存在Meckel憩室后,经脐扩大切口,行憩室切除术。23例行阑尾切除术,4例行回盲部固定术。手术时间为(45±4)min,术后通气时间为(12±3)h,住院时间(5.5±0.6)d。无伤口感染、切口裂开及粘连性肠梗阻等并发症出现。术后随访6个月~3年。2例复套,1例空气灌肠复位,1例再次镜下手术复位。1例术后3个月以肠套叠再次入院,灌肠复位后行CT检查发现腹腔内肿物,术后病理诊断为Burkitt淋巴瘤。结论腹腔镜治疗小儿肠套叠是值得推广的、安全有效的手术方法。合理地选择病例及合适的手术方案是腹腔镜肠套叠镜下复位成功及减少创伤、减少复发的关键。

Objective To explore the application and operation of laparoscopic treatment of intussusception in children.Methods From January 2013 to June 2019,53 children with acute intussusception were successfully treated by laparoscopic operation or laparoscopic assisted operation.During the operation,laparoscopy was used to explore the pathological changes.Results The reduction was successful in 42 cases by laparoscopy,9 cases assisted by air enema,with the reduction rate of 96.23%;the reduction was difficult in 2 cases,and then successful by extending the incision through the navel.After Meckel's diverticulum was found by laparoscopy in 2 cases,the diverticulectomy was performed by expanding the incision through the navel.23 cases underwent appendectomy and 4 cases underwent ileocecal fixation.The operation time was(45±4)min,the postoperative ventilation time was(12±3)h,and the hospitalization time was(5.5±0.6)d.No complications such as wound infection,incision rupture,or adhesive ileus occurred.The patients were followed up for 6 months to 3 years.2 cases were reattached,among whom 1 case underwent air enema reduction,and 1 case underwent laparoscopic operation again.One case was admitted to our hospital with intussusception 3 months after operation,the intraperitoneal mass was found by CT examination after reduction of enema,the postoperative pathological diagnosis was Burkitt lymphoma.Conclusion Laparoscopic treatment of intussusception in children is worth popularizing,safe and effective.The key to the success of laparoscopic intussusception reduction and the reduction of trauma and recurrence is to select the case and the appropriate operation plan.