先天性肠旋转不良诊治分析:单中心10年经验总结

Diagnosis and treatment of congenital malrotation of the intestine:a summary of 10 years of experience in a single center

目的回顾性分析单中心10年的先天性肠旋转不良患儿病例,进行经验总结。方法回顾性分析2012年1月至2022年2月手术治疗的155例先天性肠旋转不良患儿的临床资料。根据手术方式不同分为腹腔镜组(n=60)和开腹组(n=95),腹腔镜组根据手术时间的先后顺序依次分为6个阶段(A组~F组,每组平均10例)。采用SPSS 23.0进行统计学分析,围手术期指标等计量资料以(x±s)表示,采用独立样本t检验;术后并发症用[例(%)]表示,采用χ^(2)检验。P<0.05为差异有统计学意义。结果腹腔镜组手术时间长于开腹组,术中出血较开腹组多,总住院时间较开腹组短(P<0.05);两组患儿术后肠扭转复发、粘连性肠梗阻、切口感染比较,差异无统计学意义(P>0.05);腹腔镜组手术时间绘制学习曲线,发现在完成20例手术后,手术时间由学习期过渡到熟练期。结论腹腔镜手术治疗肠旋转不良可减少住院时间,但手术时间较长,腹腔镜下肠旋转不良复位术的学习曲线大概是20例,由经验丰富的团队施行该术是安全可行的。

Objective The cases of congenital malrotation of the intestine in a single center for 10 years were retrospectively analyzed and the experience was summarized.Methods The clinical data of 155 children with congenital malrotation treated by operation from January 2012 to February 2022 were retrospectively analyzed.According to different surgical methods,they were divided into laparoscopic group(n=60)and open group(n=95).The laparoscopic group was divided into 6 stages according to the sequence of operation time(group A to group F,with an average of 10 cases in each group).SPSS 23.0 was used for statistical analysis.Measurement data such as perioperative indicators were expressed as(x±s)and independent sample t test was used.Postoperative complications were represented by[cases(%)]andχ^(2)test was used.P<0.05 was considered statistically significant.Results The operation time of laparoscopic group was longer than that of laparotomy group,the intraoperative bleeding was more than that of laparotomy group,and the total hospital stay was shorter than that of laparotomy group(P<0.05).There was no significant difference in postoperative recurrence of intestinal torsion,adhesive intestinal obstruction and incision infection between the two groups(P>0.05).The learning curve of laparoscopic operation time was plotted,and it was found that after 20 cases of operation,the operation time changed from the learning period to the proficiency period.Conclusion Laparoscopic surgery for malrotation can reduce the length of hospital stay,but the operation time is longer,the learning curve of laparoscopic malrotation reduction is about 20 cases,and it is safe and feasible to perform this procedure by an experienced team.