完全腹腔镜手术治疗小儿消化道异物磁力珠10例分析

Complete Laparoscopic Surgery for Foreign Body of Magnetic Beads in Digestive Tract in Children:Analysis of 10 Cases

目的探讨完全腹腔镜手术治疗小儿消化道异物磁力珠的可行性及安全性。方法回顾性分析2019年1月~2020年8月郑州大学第三附属医院5例、郑州大学第一附属医院2例及河南省儿童医院3例消化道异物磁力珠行完全腹腔镜手术的资料,年龄2岁2月~5岁6月,中位年龄3岁9月。腹腔镜下探查确定磁力珠的位置,松解粘连的肠管,自胃肠穿孔处逐一取出磁力珠,缝合修补穿孔,检查吻合口无漏气漏液,腹腔留置引流管。结果9例有胃肠穿孔,完全腹腔镜手术修补;1例无胃肠穿孔,经脐部2 cm小切口将磁力珠挤入盲肠自行排出。手术时间110~190 min,平均144 min,术中出血量<20 ml。术后第2~3天肛门排气,第3~4天行腹部X线片无异常后进流食,第7天拔除腹腔引流管,第7~10天出院。10例术后随访3~20个月,平均13个月,无吻合口狭窄、肠瘘、粘连性肠梗阻等并发症发生。结论完全腹腔镜手术治疗小儿消化道异物磁力珠安全、可行。

Objective To investigate the feasibility and safety of complete laparoscopic surgery for treating pediatric digestive tract foreign bodies of magnetic beads.Methods Clinical data of pediatric patients undergoing complete laparoscopic surgery,including 5 cases from Third Affiliated Hospital of Zhengzhou University,2 from First Affiliated Hospital of Zhengzhou University and 3 from Henan Children’s Hospital between January 2019 and August 2020,were retrospectively analyzed.Their ages ranged from 2 years and 2 months to 5 years and 6 months old,and the median age was 3 years and 9 months old.Under laparoscopic surgery,the position of the magnetic beads was determined and the adhesive bowel was released.The magnetic beads were removed one by one from the gastrointestinal perforation.Then the digestive tract was sutured and repaired.No air or liquid leakage was found at the anastomotic stoma.A drainage tube was placed in the abdominal cavity.Results A total of 9 patients had gastrointestinal perforation,who received total laparoscopic surgery successfully;1 case had no gastrointestinal perforation,and the magnetic beads were pushed into the cecum through a 2 cm incision in the umbilicus and discharged by themselves.The operation time was 110-190 min,with an average of 144 min.The blood loss was less than 20 ml.The patients had anal exhaust on day 2 or 3 after the operation.Liquid diet was given after normal abdominal X-ray on day 3 or 4.The abdominal drainage tube was removed on day 7.The patients were discharged from the hospital 7-10 days after the operation.The patients were followed up for 3-20 months and the average follow-up time was 13 months.No anastomotic stenosis,intestinal fistula,adhesion intestinal obstruction or other complications occurred.Conclusion Complete laparoscopic surgery for treating foreign body of magnetic beads in children’s digestive tract is safe and feasible.